CareSource, Ohio’s largest Medicaid managed care organization, is beginning to take back money from payments it made to healthcare providers within the last two years. <\/p>\n
Mental health providers across the state are being asked to return 15% of payments for services that were already completed- and already paid for.<\/p>\n
One of those providers is Circleville Community Counseling, a small practice that serves a Medicaid-based population. It’s practice contacted ABC 6 after receiving bills for thousands of dollars. Owner Brenton Beckley says the sudden claw backs are creating financial strain and uncertainty.<\/p>\n
“This takes the wind out of your sales a little bit to get something like this,” Beckley said. “I don’t think they had the best interest of all of their providers at heart. We are responsible of these claw backs. We’re just trying to help people and a big insurance company wants to just take it back.”<\/p>\n
According to Beckley, the practice has received multiple bills in recent weeks, including charges for +$1,200 and +$600. If those bills aren\u2019t paid, the funds could be automatically deducted from future payments.<\/p>\n
“The funds will be recovered through offsets to future claim payments until paid in full,” the bill stated from CareSource. <\/p>\n
CareSource has indicated the recoupments could go back as far as two years of past claims, raising concerns among providers about the scale of the issue.<\/p>\n
“Following our standard practice, we informed these providers that we need to recoup these overpayments and will reimburse them at the correct contractual rates moving forward,” a CareSource representative told ABC 6. “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
The Ohio Department of Medicaid says it is aware of the situation and is currently reviewing whether the payment take-backs comply with state and federal regulations. Officials are also examining whether providers were given proper notice and whether patient access to care could be affected.<\/p>\n
“Ohio Medicaid is actively engaging with CareSource to confirm 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, and that member access to critical behavioral health services is not compromised,” a spokesperson for the Ohio Department of Medicaid told ABC 6. <\/p>\n
“Medicaid is a little thrown off because this was this was genuinely on CareSource,” Beckley added. “This is a decision that they have made from from the top that they are going to retroactively change things. We feel defeated at times. We’re trying to do this to serve people that otherwise couldn’t afford help.”<\/p>\n
Beckley fears that continued claw backs may force providers to cut services or even close, which could limit access to mental health care for Medicaid patients.<\/p>\n
Despite the uncertain future with CareSource, Beckley says his practice will continue to serve patients, even if it means a smaller bank account. <\/p>\n
“That is ethical and it’s the right thing for us to do,” Beckley added. “We’re not going to kick our people to the curb. But it also means that we will tell them of the other options out there available to them and to find one that fits their needs.”<\/p>\n