Mental health providers across Ohio say they’re facing unexpected financial strain after being told to repay thousands of dollars in Medicaid reimbursements for services dating back as far as two years.Several therapists who contacted WLWT say they recently received “overpayment recovery” notices from CareSource, one of the largest Medicaid managed care providers in the state. The notices indicate the company plans to recoup a portion of previously paid claims—sometimes by withholding future payments.For small practices, providers say the impact could be significant.”If they continue with this for the full two years, it will be about $15,000,” said Jenny Liu, a therapist and owner of Conscience Roots Counseling. “For a small practice, that’s a big deal.” Liu said her practice serves about 80 clients and intentionally accepts Medicaid to help meet a growing need for mental health services. She said the repayment demand came without prior warning.”We’ll get $0 until we back the 15%,” she said. Liu and other providers say that means future reimbursements for current services could be reduced or eliminated entirely until the balance is repaid.Providers warn of ripple effectsTherapists tell WLWT this is not an isolated issue. Multiple providers across Ohio say they’ve received similar notices, and some are now weighing difficult decisions about their future.”There will not be enough therapists out there to meet the need. ” Liu said. Some providers say they may be forced to stop accepting Medicaid patients or close their practices altogether if the recoupments continue.Others say they are now exploring legal options, including the possibility of a broader lawsuit.CareSource: ‘Overpayments’ identified during reviewIn a statement to WLWT, CareSource said the recoupments stem from a review that found some behavioral health providers had been overpaid.The company said recovering those funds is part of its responsibility to properly manage Medicaid dollars.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.”State reviewing whether process follows rulesThe Ohio Department of Medicaid confirmed to WLWT that it is aware of the situation and is now reviewing whether the recoupments are being carried out appropriately.Full statement from the Ohio Department of Medicaid:”We are aware of recent reports that CareSource, a Medicaid managed care organization, has initiated retroactive recoupments of behavioral health reimbursements.Ohio Medicaid understands concerns this action may raise among providers. We are reviewing whether these recoupments are consistent with both Ohio’s Medicaid managed care regulations and federal guidelines set forth under 42 CFR 438, which govern managed care organizations’ obligations around overpayment recovery, including prompt reporting and reasonable notice.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.That member access to critical behavioral health services is not compromised.We remain committed to supporting a stable provider network and ensuring that Ohio’s Medicaid-supported services continue with minimal disruption. For more information on CareSource’s actions, please reach out to the plan.”What happens nextFor now, providers say they’re left trying to navigate the repayment process, while continuing to serve patients.Liu said she’s doing everything she can to keep her practice open, but the uncertainty is weighing heavily.”I hope I don’t have to close the practice… but it’s possible right now,” she said.
CINCINNATI —
Mental health providers across Ohio say they’re facing unexpected financial strain after being told to repay thousands of dollars in Medicaid reimbursements for services dating back as far as two years.
Several therapists who contacted WLWT say they recently received “overpayment recovery” notices from CareSource, one of the largest Medicaid managed care providers in the state. The notices indicate the company plans to recoup a portion of previously paid claims—sometimes by withholding future payments.
For small practices, providers say the impact could be significant.
“If they continue with this for the full two years, it will be about $15,000,” said Jenny Liu, a therapist and owner of Conscience Roots Counseling. “For a small practice, that’s a big deal.”
Liu said her practice serves about 80 clients and intentionally accepts Medicaid to help meet a growing need for mental health services. She said the repayment demand came without prior warning.
“We’ll get $0 until we back the 15%,” she said.
Liu and other providers say that means future reimbursements for current services could be reduced or eliminated entirely until the balance is repaid.
Providers warn of ripple effects
Therapists tell WLWT this is not an isolated issue. Multiple providers across Ohio say they’ve received similar notices, and some are now weighing difficult decisions about their future.
“There will not be enough therapists out there to meet the need. ” Liu said.
Some providers say they may be forced to stop accepting Medicaid patients or close their practices altogether if the recoupments continue.
Others say they are now exploring legal options, including the possibility of a broader lawsuit.
CareSource: ‘Overpayments’ identified during review
In a statement to WLWT, CareSource said the recoupments stem from a review that found some behavioral health providers had been overpaid.
The company said recovering those funds is part of its responsibility to properly manage Medicaid dollars.
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.”
State reviewing whether process follows rules
The Ohio Department of Medicaid confirmed to WLWT that it is aware of the situation and is now reviewing whether the recoupments are being carried out appropriately.
Full statement from the Ohio Department of Medicaid:
“We are aware of recent reports that CareSource, a Medicaid managed care organization, has initiated retroactive recoupments of behavioral health reimbursements.
Ohio Medicaid understands concerns this action may raise among providers. We are reviewing whether these recoupments are consistent with both Ohio’s Medicaid managed care regulations and federal guidelines set forth under 42 CFR 438, which govern managed care organizations’ obligations around overpayment recovery, including prompt reporting and reasonable notice.
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.
That member access to critical behavioral health services is not compromised.
We remain committed to supporting a stable provider network and ensuring that Ohio’s Medicaid-supported services continue with minimal disruption. For more information on CareSource’s actions, please reach out to the plan.”
What happens next
For now, providers say they’re left trying to navigate the repayment process, while continuing to serve patients.
Liu said she’s doing everything she can to keep her practice open, but the uncertainty is weighing heavily.
“I hope I don’t have to close the practice… but it’s possible right now,” she said.