DAYTON \u2014 News Center 7\u2019s I-Team is investigating surprise bills from one of Dayton\u2019s largest employers, demanding thousands of dollars. <\/p>\n
[DOWNLOAD: Free WHIO-TV News app for alerts as news breaks<\/a>]<\/p>\n As reported on News Center 7 at 6:00, this has to do with Medicaid payments that CareSource says should not have been paid to mental health providers across the state. <\/p>\n TRENDING STORIES:<\/p>\n Now the company wants the money back. <\/p>\n The I-Team has learned this has gotten the attention of state oversight officials in Columbus.<\/p>\n Carla Urbanas has been a mental health counselor for 30 years. <\/p>\n These days, she has a private practice with offices in Centerville and Vandalia. <\/p>\n \u201cWe will see clients when they\u2019re having difficulties, whether it be any kind of mental health issues. It can be family issues, marital issues. We see kids when they\u2019re struggling. I specialize specifically in seeing first responders. So all of my clients are police and firefighters,\u201d Urbanas said. <\/p>\n Urbanas told the I-Team that about 10% of the clients that come into her practice have Medicaid insurance through CareSource.<\/p>\n \u201cOnce we see a client, then basically what happens is that our billing company will bill electronically to CareSource, and then CareSource reimburses us for the contracted fee for that client,\u201d she said.<\/p>\n But this week, she said something else came in the mail <\/p>\n \u201cI already had $3,000 worth of recoupment sitting there waiting for me, and no notice had been given at all,\u201d Urbanas said. \u201cIt was $3,000 to start with, that\u2019s just their first round.\u201d<\/p>\n She shared a copy of one of the payback demand letters from CareSource with the I-Team. <\/p>\n It says there was an overpayment. <\/p>\n Urbanas clawbacks go back to 2024. <\/p>\n \u201cI know a colleague that actually got a bill for $60,000 the other day from CareSource because of this,\u201d Urbanas said. <\/p>\n She said so far, her bills are significant but survivable. <\/p>\n She worries about the ripple impacts, and colleagues stuck trying to pay hefty bills they can\u2019t afford. <\/p>\n \u201cI know that there are a lot of other practices in the area that this will put them under, which means that we could significantly have problems with even worse access to mental health services,\u201d Urbanas said. <\/p>\n In a statement sent to the I-Team, a CareSource spokesperson said: <\/p>\n \u201cCareSource\u2019s mission is to improve the health and well-being of Ohioans. As part of this commitment, we responsibly manage Medicaid funds to maintain high-quality, affordable care. During a recent review, we identified that some behavioral health providers have been historically overpaid for certain services. <\/p>\n Following our standard practice, we informed these providers we need to recoup these overpayments and will reimburse them at the correct contractual rates moving forward. This is not a rate reduction, but rather an effort to ensure CareSource is accurately paying claims in accordance with our fiduciary duty as a steward of public funds. <\/p>\n We understand this may cause concern for some providers, and we are committed to working with them to review their individual circumstances. <\/p>\n Throughout this process, we remain focused on protecting our members\u2019 access to quality care and supporting provider network stability.\u201d<\/p>\n Urbanas overpayment notice lays out the payment plan and dispute rights. <\/p>\n It also said that if she takes no action after 30 days, CareSource will offset future claim payments until the debt is repaid.<\/p>\n \u201cWhat I would like for them to know is that we deserve to get paid for the services that we provide, and we don\u2019t ask for a lot. We do it because we care about these people, but we also have to be able to keep our doors open. And when they come and take money like that from us, we don\u2019t have that kind of money to give back to them,\u201d Urbanas said. <\/p>\n She said she\u2019s also talking to her lawyer about options, including potentially joining class action lawsuits being considered. <\/p>\n The Ohio Department of Medicaid said it is looking into whether these CareSource clawbacks are consistent with state and federal regulations and whether they comply with legal and contractual timeframes. <\/p>\n A spokesperson with the Ohio Department of Medicaid provided the following statement: <\/p>\n \u201cWe are aware of recent reports that CareSource, a Medicaid managed care organization, has initiated retroactive recoupments of behavioral health reimbursements.<\/p>\n Ohio Medicaid understands concerns this action may raise among providers. We are reviewing whether these recoupments are consistent with both Ohio\u2019s Medicaid managed care regulations and federal guidelines set forth under 42<\/a>\u202f<\/a>CFR<\/a>\u202f<\/a>438<\/a>, which govern managed care organizations\u2019 obligations around overpayment recovery, including prompt reporting and reasonable notice.<\/p>\n Ohio Medicaid is actively engaging with CareSource to confirm:<\/p>\n Whether these recoupments comply with statutory and contractual timeframes.That impacted providers received appropriate notifications and opportunities to dispute or repay in alignment with both state and federal requirements.That member access to critical behavioral health services is not compromised.<\/p>\n We remain committed to supporting a stable provider network and ensuring that Ohio\u2019s Medicaid-supported services continue with minimal disruption.”<\/p>\n News Center 7 will continue to follow this story. <\/p>\n