A judge ruled that the government underpaid medical providers who issued vaccinations to low-income children.

North Carolina may owe more than $20 million to medical practices throughout the state because a Superior Court judge ruled last month that the government underpaid them for the cost of giving vaccines to lower-income children.

Superior Court Judge Beecher Gray of Durham ruled in Wayne County Superior Court that the state Department of Health and Human Services was required by federal regulation to pay the doctors’ offices $20.45 for each vaccine administered. The vaccines were given to children in the federal Vaccines for Children program in 2013 and 2014.

The state paid the medical providers $13.71 for each vaccine instead of $20.45, a difference of $6.74 per vaccine.

Gray ordered the Department of Health and Human Services to pay the the medical practices the difference within 120 days. Plaintiffs’ lawyer Joey Ponzi said the ruling affects an estimated 2 million to 3 million vaccinations. This would put the state’s bill to between $13.48 million and $20.22 million.

The state is still deciding whether to appeal Gray’s ruling, a spokeswoman for North Carolina Attorney General Josh Stein said on Wednesday.

The ruling is dated Sept. 29 and was filed Oct. 4.

The Vaccines for Children program provides common childhood vaccinations, such as those for measles, chickenpox and diphtheria, to lower-income children at no cost to their families, said physician Ashok Jain of Hope Mills-based KidzCare Pediatrics. KidzCare has offices from the North Carolina mountains to the coast.

The $20.45 payments are to cover the medical providers’ labor, storage and administration costs from giving the the vaccines to the children, Jain said. The $13.71 pay level was too low to cover those, he said.

A provision in the Affordable Care Act raised the payment to $20.45, Jain said.

Most if not all of the increase would have been covered by the federal government, Ponzi said, instead of from North Carolina tax collections.

Eight medical practices, including KidzCare, sued this year for the increased payment. The plaintiffs also included the North Carolina Academy of Family Physicians and the North Carolina Pediatric Society.

If the ruling holds, all medical practices that were underpaid in the Vaccines for Children program will be compensated, not just the plaintiffs, Gray’s ruling says.

Since the beginning of 2015, the state has paid the higher rate, Ponzi said.

Staff writer Paul Woolverton can be reached at pwoolverton@fayobserver.com, 486-3512 and 261-4710.