CLEVELAND — Northeast Ohio mental health providers fear some of their patients might have to go without care after a major insurance organization said it needs to recoup significant money.
CareSource is based in Ohio and is starting to inform some providers that it will claw back the money because of overpayments.
"I feel slapped in the face. I feel insulted. I feel gaslit,” said Sarah Papesh, who is the Chief Clinical Officer and Co-Owner of New Care Behavioral Health in Wellington. It’s a private mental health provider that uses CareSource for some clients.
CareSource helps people who need government-sponsored programs like Medicaid and Medicare. It would not go on camera, but told us it found some Ohio providers had “been historically overpaid for certain services.”
Morgan Murray is the Lead Clinician and Biller at Strive CLE Counseling in Westlake.
"We can’t negotiate the rate with you (CareSource),” said Murray. “You put that rate on the page, and now you’re saying, 'Oops, now we’re going to take that back.' That’s just unfair.”
The women said these clawback plans go against their contracts with CareSource. They also said CareSource is going back two years and reclaiming 15% of the payments it already made.
For Murray’s business, she said that’s about $25,000 so far. Papesh said it could be $50,000 for her business, and that other providers report even more substantial financial hits.
"We have counselors who have identified that they don’t think that they want to remain in the field after this,” said Papesh. “This is going to devastate our community.”
CareSource said, “This is not a rate reduction,” but this plan more aligns with being “a steward of public funds”.
Ohio law states CareSource is allowed to claw back money on overpayments, although this month, a new bill passed by the Ohio Senate wants to reduce that to one year only.
Murray said the so-called overpayments were not their errors, yet they’re paying for it.
"This is in CareSource’s system,” said Murray. “How have you not recognized this over two years?”
CareSource stated that providers can appeal the decision and that it will work with them. However, the women said the organization hasn’t done that yet, and there’s a lot of confusion.
They worry the gaps in mental health care will only get bigger.
"How do you not know how this will impact your own state? How do you not know the fallout of this long term?” said Papesh.
The women said they have 30 days to appeal, which is about mid-May, and they will fight this.
Read the full statement from CareSource:
“CareSource’s 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.
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. 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.
We understand this may cause concern for some providers, and we are committed to working with them to review their individual circumstances.
Throughout this process, we remain focused on protecting our members' access to quality care and supporting provider network stability.”
