Mental health providers in Ohio are grappling with an unexpected financial strain after being directed to repay thousands in Medicaid reimbursements for services rendered over the past two years. Several therapists who reached out to WLWT recently received “overpayment recovery” notices from CareSource, one of the largest managed care providers in the state. These notices indicate that the company intends to reclaim some of its previously issued payments, potentially by withholding future reimbursements. For smaller practices, this could have a substantial impact, according to health care providers. “If you deal with this for two whole years, you’re looking at around $15,000,” noted Jenny Liu, a therapist who owns Conscience Roots Counseling. “That’s really significant for a small practice.” Liu mentioned that her clinic serves roughly 80 clients and has chosen to accept Medicaid to address the rising demand for mental health services. She expressed that the repayment request arrived unexpectedly, stating, “It’s $0 until you cover 15%.”
Liu and other providers worry this situation means that future reimbursements for their ongoing services could be reduced or even eliminated until the owed balance is settled.
Providers warn of ripple effects
According to therapists who spoke with WLWT, this predicament is not unique. Numerous providers throughout Ohio reported receiving similar notices and are now facing tough decisions about their futures. “There’s going to be a shortage of therapists available to meet the demand,” Liu said. Some providers fear that if these recovery efforts persist, they may have to stop accepting Medicaid patients or even close their offices entirely. Others are contemplating legal avenues, including the possibility of broader litigation.
CareSource: “Overpayment” identified during review
In a statement to WLWT, CareSource explained that the repayment requirements arose from a review that identified overpayments made to certain behavioral health providers. The organization emphasized that recovering these funds is part of their duty to manage Medicaid finances properly.
Full statement from CareSource:
“CareSource’s mission is to enhance the health and wellness of those in Ohio. As a part of fulfilling this mission, we manage Medicaid funds responsibly to provide high-quality, affordable care. Our recent investigation revealed that some behavioral health providers were historically overcompensated for specific services.” CareSource clarified that this is not a rate reduction but rather a necessary adjustment to ensure accurate claims payment. They acknowledged there may be concerns for some providers and expressed a commitment to working with them to address individual situations. Throughout this process, CareSource aims to maintain members’ access to quality care and support the stability of their provider network.
The state reviews whether the process follows the rules.
The Ohio Department of Medicaid confirmed to WLWT that it is aware of the situation and is examining whether the reimbursement process is being handled appropriately.
Full statement from the Ohio Department of Medicaid:
“We know that CareSource, a Medicaid managed care organization, has begun retroactively collecting behavioral health reimbursements. Ohio Medicaid understands the concerns this action may evoke among providers and is considering whether these measures align with state and federal regulations governing Medicaid managed care organizations, particularly with respect to overpayment recovery and notification requirements.” Ohio Medicaid is actively collaborating with CareSource to ensure compliance with legal and contractual deadlines. They assured that affected providers received proper notification and had the opportunity to appeal or negotiate repayment per state and federal guidelines. Patient access to essential behavioral health services will remain uninterrupted, and the department remains committed to maintaining a stable provider network in Ohio with minimal disruption.
What happens next
Currently, health care providers are trying to navigate the repayment process while continuing to care for their patients. Liu expressed her determination to keep her clinic operational, but she admitted the uncertainty is heavy. “I really hope we don’t have to close our practices… but that could definitely happen,” she said.
