Reprinted from NASW Tips & Tools for Social Workers
March 1, 2024
Amar Desai
CEO, Optum Health
Andrew Witty, MD
CEO, United Health Group
Re: Optum United Behavioral Health Care Overpayment Requests
Dear Drs. Desai and Witty:
I am writing to you on behalf of the National Association of Social Workers (NASW), the largest association of professional social workers in the United States with a membership of 110,000. NASW works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies that achieve equity and improve lives. I am also writing to request a meeting with you regarding recent concerns our members have expressed related to claw back notices they have received from Optum Recovery Services. As you may be aware, over 50,000 clinical social workers are credentialed as mental health providers for Optum United Behavioral Health Care. Many have been significantly impacted by the Optum Recovery efforts to collect overpayment.
Background Information
Since January 2024, Optum Recovery has been seeking overpayments from clinical social workers who were paid 100 % of the physician fee schedule when they should have been paid at 75 % as stated in section 1833(a)(1)/(F) of the Social Security Act. Overpayment ranges from hundreds to thousands of dollars. 25% is being recouped. Overpayments are occurring with clinical social work providers of Optum Medicare Advantage Plans including in-network and out-of-network providers.
In addition, we want to bring the following to your attention:
Members who have small solo practices are reporting they are on the verge of closing due to the burden of excessive overpayments
Optum continues to overpay new claims
Optum has expanded its overpayment requests
Optum is offering loans with high interest rates for repayment
Reassessments are being performed which have increased some overpayments
Contracted rates have not been honored
NASW Requests
I would welcome the opportunity to meet with you to discuss NASW’s concerns regarding the impact of Optum’s overpayment recovery efforts on NASW’s members and possible measures to take to mitigate. Since Optum overpaid clinical social workers in error, we do not believe that clinical social workers should be penalized for this error. Clinical social workers provided much needed services in good faith and based on the pay rates confirmed and provided by Optum. NASW recommends the following:
contracted rates should be honored
a temporary waiver on current overpayments and establishment of a future date of implementation to provide clinical social workers with an opportunity to be properly notified about the change in reimbursement policy
90 days rather than 30 days to appeal an overpayment request which would ease the burden in re-paying thousands of dollars
future requests for overpayments should be signed and an email address provided for responses and questions
Thank you in advance for your attention to this matter. If you have any questions, please do not hesitate to contact Mirean Coleman, LICSW, Director of Clinical Practice at mcoleman.nasw@socialworkers.org or me at aestreet.nasw@socialworkers.org. If you are not the correct persons to address NASW’s concerns, please refer us to the appropriate person in leadership.
I very much look forward to hearing from you to determine how we can work together to alleviate the impact of the Optum Recovery efforts on NASW members.
Sincerely,
Anthony Estreet, PhD, MBA, LCSW-C
Chief Executive Officer
National Association of Social Workers