I’m a therapist (mental health) employed (for a few more days) at a nonprofit. All of my credentials are through the agency. I’m with several different insurance companies. My agency is big on playing games with rumors and talking bad about people. I’m not leaving on good terms but I’m very well liked by staff and I can see this being a tactic to sway people to leadership’s side.

For several reasons I got behind on my case notes. We received payment on those sessions before the note was done. The sessions were completed as submitted just not the paperwork. I was told recently that 180 sessions were late. I’d say that maybe 80 were UPMC, 60 Highmark, and the rest split up between the smaller insurance companies.

Leadership is saying that they are going to self report and that we will have to pay back all the payments on those sessions citing fraud. The documents are all in our EMR now.

For clarification I don’t think that there was anything 3 months late but I could be wrong, maybe a few at 2 months but for most clients the latest would have been at 6 weeks.

I have 2 questions. 1) Is this really fraud/are we going to have to pay it back? 2) Now that the notes are done if we did pay it back, can’t we just resubmit the claim?

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