Published by the Students of Johns Hopkins since 1896
April 16, 2024

Clinic protests “Big John” over Medicaid payments

By JACK BARTHOLET | October 25, 2012

A group from the Turning Point Substance Abuse Clinic in East Baltimore led a protest outside the Hopkins Hospital last Thursday, in hopes of garnering attention over the alleged $100,000 that they claim Hopkins affiliate Priority Partners owes them.

The Rev. Milton E. Williams, who runs Turning Point Clinic, led the protest. Turning Point Clinic is a walk-in clinic, which utilizes methadone to treat patients addicted to heroin.

“It is just us, Big John, Turning Point Clinic, whom you’ve fought and sabotaged for 10 years,” Williams said during the protest. “But today is the day of reckoning. And it’s long overdue. We are here today on your doorstep, Big John, daring to crawl out of your shadow as the self-proclaimed champions of quality healthcare, and from under your thumb, to protest — actually, to condemn — your hypocrisy and greed.”

Turning Point claims that Priority Partners has neglected to pay for new patient assessments and care—services that the clinic holds they are required to cover. Kevin Pfeiffer, the clinic’s Chief Financial Officer, explained that Medicaid rules, set by the Maryland Department of Mental Health and Hygiene, require Priority Partners to cover both new patient assessments and the costs per week of continuing care for patients, set by the state at $142 and $80, respectively.

“Just about a year ago, Priority Partners stopped paying for new patients’ assessments,” Pfeiffer said. “They did cover some, but I’d say they stopped paying for 90 percent of them.”

Pfeiffer said that he had tried to contact Priority Partners about their refusal to cover these services but that the organization never responded. When they never called back, Pfeiffer explained that he contacted Maryland Medicaid, and after doing so, he finally received a response from Priority Partners informing him that they were not going to pay.

Consequently, Pfeiffer explained that Turning Point had to inform all existing Priority Partners patients that they would have to be detoxed and leave the program. The clinic is also unable to take any new Priority Patients.

“The alternative would be that they have to pay for themselves,” Pfeiffer said. “But because these are Medicaid patients, and they’re therefore very poor, that’s not a very practical alternative for most of them.”

Turning Point informed its patients about the protest, and word spread.

“Priority Partners heard about [the protest]. They finally decided to leave a message here saying that they were going to reprocess the claims. That was about a month ago. At that point, it’s a little bit disingenuous and a little bit juvenile to say ‘oh never mind.’ And of course, the word ‘reprocess’ the last time I looked isn’t the same thing as ‘pay.’ And here we are a month later and they haven’t paid yet. So I guess, as they say, talk is cheap,” Pfeiffer said.

Hopkins declined to respond directly to questions and released a statement instead.

“We’re disappointed that Rev. Williams chooses to voice his dissent in very public and unproductive ways,” Kim Hoppe, Associate Director of Communications and Public Affairs for Johns Hopkins Medicine, wrote. “After numerous unanswered attempts to communicate with Williams and the staff at Turning Point Center, Johns Hopkins HealthCare recently notified them of our intent to terminate our participating partner agreement. We strive to help our members pursue quality treatment in a professional environment, and we regret any inconvenience this may cause for them.”

However, terminating the contract that Hoppe referenced is merely a symbolic gesture,

“That’s really just a bunch of nonsense; we don’t really do business with them under the terms of that contract,” Pfeiffer said.

As of Jan. 1, 2010, the Department of Mental Health and Hygiene altered their rules so that providers are no longer required to have a contract, under the Self-Referral Protocol for Substance abuse treatment.

“The contract is really just a fact of previous years,” Pfeiffer said. “But they informed us… that the contract would be cancelled. I assumed that’s their way of saying—or really confirming—that not only are they not paying for new patient assessments anymore, they’re not going to pay for any patients.”

Hoppe expressed the University's willingness to discuss the matter with Turning Point.

“Again, we would welcome the opportunity to discuss this directly with Rev. Williams, and continue to reach out to him in an effort to bring this to a close. Most important to us, right now, is our members and insuring they get quality care in a professional environment” Hoppe wrote.

Prior to a year ago, Priority Partners had been paying for the same services that they now refuse to cover, even after the implementation of the Self-Referral Protocol, Pfeiffer said. He elaborated that state Medicaid rules prohibit Priority Partners from withholding reimbursement for these services.

“It is absolutely not within their prerogative in any way whatsoever. They must pay. They’re required to pay,” he said.

“While we desperately try to provide care for the neediest heroin addicts of the City of Baltimore, Johns Hopkins, the City’s largest private organization, seeks the opposite!” Williams said to the protestors. “Whether out of pure greed alone, or a continuing desire to destroy Turning Point, their efforts to stop for good the good we are doing won’t work. We will not let that happen!”

Turning Point Clinic has expressed frustration with the state’s handling of the matter and remains pessimistic for the future.

“It’s kind of prickly to figure out the relationship between Hopkins and the state, but the state certainly hasn’t prevailed upon them to pay us, which is to say that… they have not enforced their own regulations is the bottom line. And I don’t see them forcing the Mighty Hopkins to do anything which gives rise to the need for litigation,” Pfeiffer said.

As a result, Turning Point Clinic is filing a class-action lawsuit against Hopkins.

“Have you no shame, Big John?” Williams said during the protest. “You are literally stealing from these folks the possibility of a drug free future! Don’t you have enough money without stealing from those with so little?”

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