Billing questions plague health providers in Maryland

Billing questions plague health providers in Maryland

Image by Darko Stojanovic from Pixabay

Capital News ServiceANNAPOLIS, Md. — Behavioral health providers, who offered mental health services and substance use treatment during the pandemic, are locked in a dispute with the Maryland Department of Health over how many millions of dollars the providers must pay back to the state.

The problems began after a new billing management company engaged by the state — touted as a money-saving move — took over reimbursements for behavioral health providers early last year.

The Maryland Department of Health reported it overpaid behavioral health providers through Medicaid and state programs by more than $359 million by October 2020, according to a health department presentation to state legislators in November.

But providers and advocates said the state, and its administrative services contractor, have not produced sufficient documentation to prove the overpayments.

Advocates for behavioral health providers and health department officials met virtually with state legislators on Nov. 4 to give updates on the issue that has lasted nearly two years.

The overpayments happened after UnitedHealth Group/Optum Maryland, a health department administrative services contractor, failed to process claims shortly after taking over the billing system for behavioral health providers in January 2020.

In response to the system failure, the health department “directed Optum to make weekly estimated payments to the approximately 2,200 behavioral health providers in the state beginning on Jan. 23, 2020 and continuing through August 3, 2020,” according to a report from the department last year.

Those weekly payments were calculated for each provider based on their 2019 historical payment average, the report said.

“This crash of the system was occuring during a pandemic, when the providers … were essential workers providing essential services,” Del. Heather Bagnall, D-Anne Arundel, said at the meeting.

The weekly payments in 2020 were based on historical volumes, but health care services were underutilized during that period and resulted in overpayments, said Steven Schuh, deputy secretary of health care financing and Medicaid director at the Maryland Department of Health.

“Maryland has a legal and moral responsibility to our federal and state taxpayers” to get money from overpayments back, Schuh said.

As of October, the outstanding balance for overpayments was about $230 million, Schuh said, as some providers already paid money back, and more are expected to pay in the spring.

“As things stand today, we frankly are pleased with the progress that is being made,” Optum executive Chad Burkholder said during the meeting. “We believe that the system is functioning … on a very consistent basis (now).”

Additionally, Schuh said that certain providers who owe $10,000 or less will not have to pay any money back, as the health department hopes to “eliminate the burden on small, community-based providers.”

Other providers — including hospitals, laboratories and out-of-state providers — must still pay money back, even if they owe less than $10,000, Schuh said.


Providers at the meeting questioned the accuracy of Optum and the health department’s numbers for overpayment amounts.

“We have to be able to check Optum’s math. Unfortunately, their system is a mess,” said Lori Doyle, public policy director at Community Behavioral Health Association of Maryland, an advocacy organization for providers.

The health department’s outstanding balance for overpayments included claims that were marked paid though the provider did not receive payment, claims that Optum denied in error, and retracted claims from 2019, according to Doyle’s presentation on Nov. 4.

“Our numbers are pretty far apart — what Optum thinks we owe and what providers think they owe,” Doyle said.

Nearly 40% of surveyed providers said their repayment numbers differ from Optum’s by 60% or more, according to Doyle’s presentation.

“In a time where there is a workforce shortage … (providers) are being faced with the administrative burden and the financial burden of having to go through all these claims,” said Michael Oliver, who represented the Maryland Association for the Treatment of Opioid Dependence at the meeting.

For months, Oliver said, providers have asked for their full claims processing history. This could help them to more easily verify the amounts they must pay the state, advocates said.

At the meeting, Del. Geraldine Valentino-Smith, D-Prince George’s, asked whether the health department has insisted on getting this full claims history from Optum.

Schuh replied, “We have asked for that information, and the system is apparently incapable of providing it.”

In April, state legislators had requested the health department provide behavioral health providers their full claims history by August, according to a state budget report.

“There has been an admission from the department that the system is not able to provide the full claims history,” Del. Kirill Reznik, D-Montgomery, chair of one of the House subcommittees that held the meeting.

Reznik said that he may talk with the state’s attorney general about bringing an independent auditor — at Optum’s expense — to do the full reconciliation, outside of the health department and behavioral health providers.

“This whole thing is not gonna be resolved until the next governor is in office. … We may have a new secretary of health. It may be a long time,” Reznik said.

“We’re not there, but it is my hope that 2022 is the year we get there,” Reznik said, ending the meeting.

Optum Behavioral Health spokesperson Christine Hauser wrote in an email to Capital News Service, “As Optum and MDH have made clear, providers currently have the claims information necessary to balance their books and begin repayment of overpayments.”

“We will continue to offer one-on-one technical support and explore additional requests to assist them,” Hauser wrote.

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Capital News Service

Capital News Service is a student-powered news organization run by the University of Maryland Philip Merrill College of Journalism. With bureaus in Annapolis and Washington run by professional journalists with decades of experience, they deliver news in multiple formats via partner news organizations and a destination Website.