Dayton Employer Suspends Surprise Charges
DAYTON — One of the major employers in Dayton is halting unexpected charges that could have totaled thousands of dollars for some mental health providers.
The I-Team at News Center 7 has been looking into Medicaid payments that CareSource claimed it had mistakenly made to mental health professionals throughout Ohio.
On April 24, CareSource sought a refund. However, news received this afternoon indicated a change in that plan.
A short time before a scheduled protest outside CareSource’s headquarters, it was revealed that the collection of these payments would be suspended. This came after a wave of concern from providers about the financial strain these demands could impose.
During a protest last Friday, providers voiced their frustrations with chanting: “No more cuts, no more greed, just give us what our providers need.”
Among those affected is Carla Urbanas, a mental health counselor with three decades of experience. She noted that about 10% of her clients in Vandalia and Centerville are insured by CareSource.
Urbanas explained how billing works: “After a session, our billing company sends an electronic bill to CareSource, and then we get reimbursed.” This is similar for half the clients at Holly St. Pierre’s clinics in Kettering, Inglewood, and Lebanon. St. Pierre emphasized, “We are treating vulnerable populations.”
Last week, both therapists began receiving initial repayment requests from CareSource, which left St. Pierre anxious about future bills accumulating. She feared that if the letters kept coming, she could owe around $25,000. “If that happens, I’d have no choice but to close my practice,” she said.
On the day of the protest, Urbanas shared a letter from CareSource indicating the suspension of collection demands. The letter stated that, after discussions with providers, it was decided to halt these overpayment collections due to the significant financial burden they could create and their potential to impact access to care for members.
Urbanas felt relieved but remained cautious. “This is good news, finally some time to sort things out,” she mentioned. Yet, she recalled that rates were still set to drop moving forward.
CareSource previously informed the I-Team that an investigation uncovered that some mental health providers had been overcompensated for specific services in the past. They planned to adjust these payments going forward to align with the correct contracted rates.
Meanwhile, the Ohio Department of Medicaid is looking into whether CareSource’s repayment requests meet legal and contractual standards. When asked if the recent changes by CareSource were influenced by this investigation, a spokesperson responded that the decision was made independently.
They reiterated their commitment to ensuring compliance with state and federal requirements and acknowledged the concerns from mental health providers. “We’re evaluating practices to ensure Medicaid policies support both providers and the individuals we help,” they stated.
A CareSource representative emphasized their belief in the right to high-quality behavioral health care and acknowledged the valuable role of providers in facilitating that care.
“Earlier this month, we recognized that we had incorrectly compensated some providers. After discussions with them, we’ve chosen to suspend these repayments,” they confirmed. They also described how future claims would be handled correctly based on contracts with specific circumstances for payment.
As the costs tied to behavioral health services increase, CareSource expressed a continued commitment to collaborating with Ohio’s health care community to maintain a robust and sustainable system.
News Center 7 will keep following this developing story.
