Autism Provider Sues Massachusetts to Block MassHealth Recoupment
An autism therapy provider affiliated with LEARN Behavioral has filed suit against 10 Massachusetts public officials and entities to stop MassHealth's effort to recoup millions of dollars from autism therapy providers for services delivered in 2024. Providers have publicly criticized the recoupment effort as flawed since the spring, and the lawsuit seeks to halt the clawback before it proceeds further. The case centers on disputes over billing or payment methodology used to calculate the recoupment amounts. The outcome could affect how MassHealth and other state Medicaid programs pursue retrospective recoupments against behavioral health providers.
A ruling against MassHealth could set precedent limiting states' ability to pursue retroactive recoupments from behavioral health providers, directly affecting provider cash flow and state program integrity efforts.
Behavioral Health
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