Proposed bill would protect Oregon mental health workers from insurance audits

House Bill 2455 would place restrictions on how insurers and coordinated care organizations can audit mental health providers in Oregon, the Lund Report reported March 16. 

The bill would also limit these entities' ability to demand reimbursements flagged by audits and would no longer allow auditors to receive incentives based on how many overpayments they find. 

It would additionally require insurers and coordinated care organizations to give detailed information to providers about audits and notify providers within 30 days of changes to audit requirements. They would also need to complete an audit within 180 days and allow providers to fix errors. 

Current auditing practices are discouraging mental health providers from continuing to work in the state, according to the publication. 

"We have to have things in place to make sure that people are getting good care and that nobody's frauded the system, occasionally that does happen," Rep. Rob Nosse, a sponsor of the bill, told the publication. "But I think that part of what we're also hearing is that there's just a level of scrutiny that is expensive, makes the job, frankly, not as rewarding or challenging, and is taking away from providing patient care when we know we're in a bit of a behavioral health crisis."

Opponents of the bill fear it conflicts with federal auditing requirements of Medicaid and may lead to overbilling for patients.

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