Optum Behavioral Health Releases the First of Two Mass Overpayment Notices

A number of licensed clinical social workers (LCSWs) across the country are facing a mass clawback effort launched by UnitedHealth Group’s (NYSE: UNH) services division, Optum.

The company’s Medicare Advantage plans overpaid the LCSWs “due to an error within a claims payment system,” a representative of Optum Behavioral Health told Behavioral Health Business. Optum Recovery Services is seeking recovery of overpayments made for services provided in the last two years, from Jan. 1, 2022 to Feb. 24, 2024. It sent its first overpayment notices in December.

The National Association of Social Workers (NASW) has received over 400 calls from members seeking guidance on the matter. The overpayment, resultant clawback efforts, and other alleged missteps in rectifying the situation are putting substantial pressure on clinicians trying to treat an underserved population, the association says. 


“Members who have small solo practices are reporting they are on the verge of closing due to the burden of excessive overpayments,” NASW said in an open letter penned by CEO Anthony Estreet on March 1. “Since Optum overpaid clinical social workers in error, we do not believe that clinical social workers should be penalized for this error.”

The NASW says that Optum Behavioral Health paid Medicare Advantage some claims for LCSW services at 100% of the Medicare physician fee schedule rate for psychologists. However, the Centers for Medicare & Medicaid Services require LCSWs to be paid at 75% of that rate. In other words, Optum Behavioral Health is seeking to recoup 25% of reimbursements paid via the Medicare Advantage plans. 

Optum’s fact sheet dated March 24 states that out-of-network LCSWs are obligated to repay, while in-network LCSWs can dispute the clawback.


LCSWs who billed the Medicare Advantage plan in- and out-of-network alike have reported to the NASW that they received the overpayment notification from Optum Recovery Services even though “covered behavioral health services provided by an in-network LCSW are out of scope for this recovery of overpayments,” the Optum Behavioral Health representative told BHB.

The NASW started receiving calls about the mass clawback in January, and the number of calls rapidly increased in February, Mirean Coleman, clinical practice director for NASW, told BHB. The association alerted its membership about the issue in January, according to its website

The amounts sought by Optum Recovery Service range from “a hundred to thousands of dollars,” Coleman said. UnitedHealth Group executives did not tell NASW how many LCSWs have been impacted.

“​​Since overpayments and recoupment are relatively rare occurrences in behavioral health, some providers may not be used to receiving these notifications,” Optum said in its fact sheet.

NASW sent its open letter to UnitedHealth Group and Optum Health leadership, requesting a meeting and that the company consider specific actions. It also shared details that NASW members had reported to the association:

— Overpayments continue even as Optum Recovery Service seeks to collect on overpayments

— Optum Recovery Services is expanding the scope of the recovery effort beyond the Medicare Advantage claims

— Optum is pushing high-interest loans as a means of repayment

— Other contracted rates were not being honored

An Optum Behavioral Health representative told BHB that it’s offering LCSWs impacted by the overpayment “extended, no-interest repayment plans.”

Several UnitedHealth Group executives met with Estreet, Coleman and Denise Johnson, senior practice associate for NASW, on March 18 and 21 and have been in contact since. Coleman declined to name the UnitedHealth executives who attended those meetings.

In a notice to association members on April 11, NASW said it “successfully advocated” for extended deadlines to appeal and to repay overpayments, allowing in-network social workers to dispute or request forgiveness for the overpayment and advanced notice about other overpayment requests. Out-of-network claims won’t be able to be disputed, the letter states.

“We will continue to monitor the situation, meet with Optum to make them aware of what’s going on, to see how we can address our members’ concerns about things,” Coleman told BHB. “And one of the concerns that people have is that this was an Optum problem, an Optum error, and they delivered their services in good faith.

“Our members feel they should not be penalized in this case.”

There will be another wave of overpayment notices released at some point during the second quarter of 2024 for claims with dates of service from May 1, 2023 to February 28, 2024, according to the fact sheet.

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