CCMSD countersues EMR firm

Crook County Medical Services District (CCMSD) has filed a counterclaim against the company that was until recently responsible for its electronic medical records system.

Last month, TruBridge Inc. filed a suit in the Southern District of Alabama that claimed the district broke its contract when it ceased to use the company’s services and therefore owes just under $1 million in damages.

CCMSD, on the other hand, argues that TruBridge failed to “satisfactorily perform its obligations”, which caused “significant damages” and threatened the district’s ability to remain viable and provide healthcare to its patients.

“If CCMSD breached the agreement, [TruBridge] materially breached the agreement first,” states the district’s rebuttal, claiming that its actions were a direct result of Trubridge’s failures.

The district’s counterclaim alleges that CCMSD, not TruBridge, is the party that deserves compensation.

Complaint Response

TruBridge’s suit against the district alleges that, in around October, 2022, TruBridge claims it learned that the Board of Trustees was considering a transition to a new EMR system. The company’s counsel sent a letter to CCMSD outlining the agreement between the parties, “including the fact that TruBridge has the exclusive right” to provide these services and that they are “not severable from the agreement”.

According to the complaint, CCMSD did not respond.

TruBridge claims it later learned that CCMSD intended to implement a new system by its competitor.

“CCMSD effectively terminated the agreement before the end of the then-existing service term, depriving TruBridge a service fee for its services,” the complaint states.

The complaint states that TruBridge advised CCMSD that the total amount due for the service term ending July, 2026 is approximately $992,355.84.

In response, CCMSD has submitted a list of defenses, such as that TruBridge has failed to state a claim upon which relief can be granted and needs to provide proof of the claims it has made. CCMSD asserts ‘anticipatory repudiation’: the concept that one party to a contract does not intend to fulfill its obligations, which can be seen through actions that demonstrate a refusal to perform.

CCMSD also points out that it is a special hospital district.

“As such [it] is a local governmental entity of the State of Wyoming entitled to governmental and sovereign immunity and the protections of the Wyoming Governmental Claims Act,” states the response.

This, it continues, includes the requirement for notice of a governmental claim before a suit is filed against CCMSD and the protections of the Eleventh Amendment, which limits the ability of people to sue states they are not citizens of in federal court.

Even if CCMSD is not immune from the lawsuit, states the rebuttal, the Wyoming Governmental Claims Act limits its liability to $250,000.

In addition, the district argues that, pursuant to Wyoming law, the agreement between the two entities was voidable by the district – and that its actions were “necessary to ensure the safety of the public”.

Counterclaim

CCMSD’s counterclaim states that TruBridge was contracted to provide electronic medical records and accounts receivable management services, including the billing of all patients.

However, CCMSD claims that the system did not “function as required”. In August, 2021, TruBridge agreed to make a physician available to work through the issues, but failed to do so for three months; when the physician finally did meet with providers, CCMSD claims it was for only one day, during which time he “failed to answer any of their questions” and then didn’t return the next day.

In the same month, CCMSD alleges that it advised TruBridge of concerns from providers that the system was “unsafe for patients”, has no clinical monitoring tools and lacks patient outcome research. The district shared a list of worries, but says TruBridge “did not respond substantively”.

In March, 2023, “TruBridge finally offered CCMSD an ‘optimization team’ to assist in resolving the issues,” but this was never implemented. The district alleges that TruBridge also experienced turnover issues that resulted in it working with three different “client success managers” in two years.

TruBridge never resolved CCMSD’s concerns, states the counterclaim.

“Providers also continued to deal with bottlenecks, resulting in the inability of CCMSD’s clinics to timely get patients in and out the door, delayed ordering imaging and labs and delayed obtaining imaging, laboratory and other results,” it states.

“As a result, CCMSD was also forced to hire additional clinic staff to perform document management.”

Meanwhile, CCMSD alleges that TruBridge breached the agreement by failing to perform accounts receivable management services – a services, it says, that is, “critical to the financial survival of CCMSD, to the professionals performing medical services at CCMSD’s hospital and to CCMSD’s ability to provide quality healthcare.”

The district’s accounts receivable grew and stayed high, according to the counterclaim: from a previous monthly gross average of $1,758,521, it increased to $3,255,352.

The counterclaim attributes this to the fact that its aging of accounts over 120 days increased “dramatically”, which made recovery of them less likely.

“Rather than following up on unpaid invoices, such as determining the reason for any rejections or delays in payment, TruBridge, at most, simply resubmitted the invoices and later advised CCMSD write off the same,” states the counterclaim.

This allegedly created a need for CCMSD to hire a contractor in order to provide cash flow and mitigate damages, as well as an outside firm to prepare financials for the Board of Trustees.

As a result of all this, the district says, hundreds of thousands of dollars are likely now uncollectible and CCMSD was forced to transfer $1.7 million from CDs and the construction fund to pay business expenses. According to the counterclaim, it also led to patient complaints of bills issued late or with errors.

CCMSD claims that the amount of accounts receivable currently in TruBridge’s system is $1,856,884, which is declining in collectible value as time goes by.

District’s Requests

In its counterclaim, CCMSD has asked the court for permission to immediately contract with another provider for accounts receivable and billing services, as well as immediate release of accounts to allow the district to pursue collections without interference from TruBridge.

The district has asked for any assets held for CCMSD by TruBridge to be frozen and for the company to be ordered to remit any and all sums due and cease any collection activity on behalf of the district.

CCMSD has also requested that the court enter a judgment “in an amount to be determined through discovery and proven at trial plus applicable attorney fees, interest and costs.”