One of Oregon’s largest Coordinated Care Organizations has filed a lawsuit against the state for having an “unsound rate-setting process.”
FamilyCare Health serves about 120,000 Portland residents on the Oregon Health Plan.
The company said in the past three years, it’s received the lowest reimbursement rates of any CCO — in one case 17 percent less than its neighbor.
FamilyCare spokesman Jack Coleman said they were forced to file suit after the state refused to provide data to show how rates were calculated.
“In some cases, we’re told that the data is proprietary. In another case, we get no information at all,” Coleman said.
Coleman said they want “transparency and fairness” in the rate setting process.
This is not the first time FamilyCare has filed suit against the state on this issue.
The Oregon Health Authority doesn’t comment on on-going lawsuits, but spokesman Robb Cowie said its rates are fair and approved by the federal government.