Hawaii doctor prevails in high court decision regarding reimbursements

"It felt good that at least the state Supreme Court justices were fair and they looked at the evidence," said Nitta. "It looks like that's the end result - these guys are going to be on it, and they're not going to let people get away with injustice."

Nitta has been a board-certified obstetrician-gynecologist in Hawaii since 1993. With over 90% of Nitta's patients eligible for Medicaid or Medicare, he also provides primary care physician, or PCP, services for his patients, earning a reputation as Hilo's welfare doctor.

To assist his work as a PCP, a staff member from Nitta's office enrolled him in the enhanced payment program via the state Department of Health Services website, which provides a reimbursement for medical treatment and services provided to patients with Medicaid.

While the 2010 Affordable Care Act was designed to encourage physicians to provide this expanded care, DHS claimed Nitta was ineligible to receive the reimbursements because he did not satisfy requirements regarding his "primary specialty designation." The DHS claimed that because Nitta was designated as an OB/GYN instead of a family medicine, general internal medicine or pediatric medicine specialist, he was ineligible for reimbursement.

In November 2015, the DHS demanded Nitta repay the $205,940.13 given to him via the Medicaid enhanced payments for services conducted in 2013 and 2014.

"I could have just paid them back," said Nitta. "Instead, it's probably costing me more to fight them in court over and over and over. But that doesn't matter, because it's not right what they're doing."

The lawsuit set off an ongoing battle that culminated in a win for Nitta back in February, when state Intermediate Court of Appeals published an opinion that - based on a previous ruling in a Tennessee case - stated the court wrongly concluded Nitta was ineligible for enhanced payments.

The DHS appealed the decision, contending that Nitta was ineligible because his "primary specialty designation" was still OB/GYN. But when the appeal made its way to the Supreme Court, justices sided unanimously with Nitta.

"We disagree with DHS … that Dr. Nitta was not eligible for the program under the statute," the ruling stated. The justices also ruled that a physician can have more than one speciality, that Nitta self-designated as having one of the requisites, and that DHS's other points "lack merit," including that the DHS was required to recoup the overpayment because there was never money appropriated to Nitta.

While the issue has been resolved at the state level, Nitta thinks it could continue forward to the national level.

"They might appeal this to the U.S. Supreme Court, but if they do, so be it," he said. "I don't get too happy or too sad no matter what happens, because this is a long-term battle."

While the win on Friday is another step toward vindication for Nitta, he anticipates the health care conflicts he faces will be ongoing.

"This case is the perfect example. There were a lot of physicians that were attacked like this with enhanced payment, and I'm the only one that I know of that fought it and took it to court," he said. "And this is only one thing. There's more than a hundred different scams they're running, and all of those you're going to see in court one day, hopefully."

Email Grant Phillips at [email protected].