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UnitedHealth breach takes toll on healthcare providers to the nation's poor

UnitedHealth Group's headquarters building is seen in Minnetonka, Minnesota, U.S. in this handout photo taken in 2019

CHICAGO, March 20 (mod1s) - The ransomware assault on UnitedHealth that has blocked payments to U.S. physicians and healthcare institutions statewide for a month, has taken a particularly painful toll on the community health centers that serve more than 30 million poor and uninsured people. 

Many big healthcare clinics have been able to start collecting payments and issuing claims following the attack by utilizing alternate systems, UnitedHealth said.

But technical bottlenecks have kept many community health centers from rejoining, according to conversations with national and state-based organizations representing them, two national groups representing Medicaid directors and plans and five of the impacted centers 

One Texas-based group warned if the scenario continues until the end of this month, some members would not be able to make payroll.

UnitedHealth's Change Healthcare technology is used to check insurance coverage, process claims and be reimbursed. With thousands of clients needing to shift to a new connection, UnitedHealth has issued loans and asked practices to employ workarounds while it tests and begins a new system in stages beginning this week. 

For Tulip Tree Family Health Care, which has two clinics in southern Indiana and serves 4,000 rural patients from Indiana and Illinois, the effect has been "drastic," said Executive Director Kristine Georges.

Tulip Tree has been unable to migrate to a new clearinghouse or use other workarounds offered by UnitedHealth, Georges added. Since Feb. 20, claims have been building up, amounting to a $300,000 backlog. 

Tulip Tree is one of 1,400 community health clinics that get money from the Health Resources and Services Administration to serve uninsured people. Most depend on funds from the U.S. Medicaid program for low income people and families.

Members of its 32-person staff are filing claims on paper via individual insurers' websites, a time-consuming procedure that has built up $12,000 in overtime fees in the previous two weeks. 

Even the additional shipping is a drain, she remarked. "There's no fat to cut." 

UnitedHealth has noted that certain providers may require further restoration work before they can submit claims and that not all have been able to deploy workaround solutions
The business is working with several thousand providers to assist with cash flow concerns, including major and small regional health systems and tiny, rural independent medical practices, a spokesperson said. 

He did not explain when claims processing to community health clinics would be reinstated. 

'THE MOST VULNERABLE' 

Dr. Julia Skapik of the National Association of Community Health Centers said centers get half their funding from Medicaid, approximately 10% from the Medicare program for individuals aged 65 and older and the handicapped, and the rest from commercial insurers and grants to support uninsured people. 

After many weeks, afflicted facilities are exhausted their reserves, she added. 

Some organizations, unable to access the new system, are waiting for a legacy system to be restored. Others have systems that are incompatible with suggested remedies, and others are apprehensive about rejections and if they will soon, or ever, be reimbursed for these claims, she added. 

The U.S. Department of Health and Human Services (HHS) has directed Medicaid programs to advance payments to impacted providers. 

"We have made clear to UnitedHealth Group our expectation that no provider be left behind," an HHS spokesman stated. 

John Baackes, chief executive of L.A. Care Health Plan, which serves low-income neighborhoods in Los Angeles County, said they are offering cash loans to tiny community-based providers, who "do not have the sophistication or staffing to turn their claims submission operation quickly." 

Isaiah Nathaniel, chief information officer of Delaware Valley Community Health, which has nine clinics in the greater Philadelphia region servicing 50,000 patients each year, said his company faced a double impact. 

While they have taken advantage of some financial support from UnitedHealth, there is still a substantial shortage since they are unable to be paid by some of their top payers, one of whom required them to submit paper claims. 

They also are unable to connect to UnitedHealth's new system since they do not yet have assurances that the system is safe. Connecting without that guarantee might put their cybersecurity insurance at risk. 

On top of that, Delaware Valley employs Change's call centers to manage appointments and medication refills at four facilities. Those are still down with no timeframe for repair. 

Lori Hooks of the Texas Association of Community Health Centers said some centers are seeing barely 30% to 50% of their claims processed, and for a few, none are getting through. 

Her group questioned members last week who indicated if the situation remains until the end of March, it may be challenging to pay bills or staff. 

"These are clinics that don't have a lot of days cash on hand and so they're the most vulnerable for not being able to make their regular monthly bills and payroll," she added.


Source: https://www.reuters.com/

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