Optum seeks clawbacks from social workers for overpayments

Optum is seeking repayment from licensed clinical social workers it says it overpaid. 

According to a March 26 fact sheet from Optum, the company incorrectly reimbursed out-of-network LCSWs for Medicare Advantage beneficiaries at 100% — instead of the intended 75% — of CMS' physician fee schedule.. 

Some small independent practices could be at risk of closing due to the overpayment demands, Anthony Estreet, PhD, CEO of the National Association of Social Workers wrote in an open letter to Optum Health and parent company UnitedHealth Group leadership. 

Over 50,000 clinical social workers are credentialed as mental health providers for Optum United Behavioral Health, according to the letter. Requested repayment amounts range from hundreds to thousands of dollars, according to the NASW. 

After meetings between Optum and NASW, the time to appeal overpayment requests was extended from 30 to 90 days, and the timeframe for repayments was extended from six months to 12. 

The request for repayment does not apply to in-network providers, according to Optum's fact sheet. 

An Optum spokesperson told Becker's that extended, no-interest repayment plans are available to impacted providers. 

"For out-of-network licensed clinical social workers, CMS has set the reimbursement rate at 75% of the CMS physician fee schedule rate. Due to an error within a claims payment system, reimbursements to out-of-network licensed social workers were made at 100% instead of 75% of the CMS physician fee schedule," the spokesperson said.  "Providers are required by CMS to refund overpayments in excess of the fee schedule." 

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