The ransomware attack on UnitedHealth that has disrupted payments to U.S. doctors and healthcare facilities nationwide for a month, has taken an especially harsh toll on the community health centers that serve more than 30 million poor and uninsured patients.
Many large healthcare centers have been able to resume
receiving payments and making claims after the hack by using alternative
technology, UnitedHealth says.
But technology roadblocks have prevented many community
health centers from reconnecting, according to interviews with national and
state-based organizations representing them, two national groups representing
Medicaid directors and plans and five of the affected centers
One Texas-based association said if the situation continues
through the end of this month, some members will not be able to make payroll.
UnitedHealth's Change Healthcare technology is used to
verify insurance coverage, file claims and get paid. With thousands of
customers needing to move to a new connection, UnitedHealth has provided loans
and urged practices to use workarounds while it tests and resumes a new system
in phases starting this week.
For Tulip Tree Family Health Care, which operates two
locations in southern Indiana and serves 4,000 rural patients from Indiana and
Illinois, the impact has been "drastic," said Executive Director
Kristine Georges.
Tulip Tree has been unable to shift to a different
clearinghouse or access other workarounds recommended by UnitedHealth, Georges
said. Since Feb. 20, claims have been piling up, amounting to a $300,000
backlog.
Tulip Tree is one of 1,400 community health centers that
receive grants from federal Health Resources and Services Administration to
cover uninsured patients. Most rely on payments from the U.S. Medicaid program
for low income individuals and families.
Members of its 32-person staff are submitting claims on
paper or individual insurers' websites, a time-consuming process that has
racked up $12,000 in overtime costs in the past two weeks.
Even the extra postage is a drain, she said. "There's
no fat to cut."
UnitedHealth has acknowledged that some providers may need
more restoration work before they can submit claims and that not all have been
able to implement workaround solutions.
The company is working with several thousand providers to
help with cash flow issues, including large and small regional health systems
and small, rural independent physician practices, a spokesman said.
He did not say when claims processing to community health
centers would be restored.
'THE MOST VULNERABLE'
Dr. Julia Skapik of the National Association of Community
Health Centers said centers receive half their revenue from Medicaid, about 10
per cent from the Medicare program for people aged 65 and older and the
disabled, and the rest from private insurers and grants to help uninsured
people.
After several weeks, affected centers are exhausting their
reserves, she said.
Some groups, unable to access the new system, are waiting
for a legacy system to be restored. Others have systems that are incompatible
with proposed fixes, and several are worried about denials and whether they
will soon, or ever, get paid for these claims, she said.
The U.S. Department of Health and Human Services (HHS) has
instructed Medicaid programs to advance payments to affected providers.
"We have made clear to UnitedHealth Group our
expectation that no provider be left behind," an HHS spokesperson said.
John Baackes, chief executive of L.A. Care Health Plan,
which serves low-income communities in Los Angeles County, said they are making
cash advances to small community-based providers, who "do not have the
sophistication or staffing to turn their claims submission operation
quickly."
Isaiah Nathaniel, chief information officer at Delaware
Valley Community Health, which has nine locations in the greater Philadelphia
area serving 50,000 patients per year, said his organization took a double hit.
While they have taken advantage of some financial assistance
from UnitedHealth, there is still a major shortfall because they are unable to
get reimbursed from some of their largest payers, one of which asked them to
submit paper claims.
They also are unable to connect to UnitedHealth's new system
because they do not yet have guarantees that the system is secure. Connecting
without that assurance could put their cybersecurity insurance at risk.
On top of that, Delaware Valley uses Change's call centers
to handle appointments and prescription refills at four centers. Those are
still down with no timeline for restoration.
Lori Hooks of the Texas Association of Community Health
Centers said some centers are seeing just 30 per cent to 50 per cent of their
claims processed, and for a handful, none are going through.
Her association surveyed members last week who said if the
situation persists through the end of March, it may be tough to pay bills or
employees.
"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 said. -Reuters