GM Director Byrd,

As you know our Medicaid patients have suffered an inordinate price paid in overdose deaths over the past 8 years due to fentanyl and other HPSOs. Finally on May 1, 2024 dosing for buprenorphine was raised to 32 mg without the continued interference of our Medicaid PBMs whose unnecessary prior authorizations historically resulted in innumerable documented treatment failures, particularly among Black patients, and disproportionately among older Black men in Washington DC.
 
Today I would now like to bring to your attention a new disturbing issue which hopefully will not take as long to resolve. Since at least October 2023, our surviving patients who consistently test positive for fentanyl / HPSOs, often now complicated by xylazine and/or cocaine and/or amphetamines, are being systematically audited and often rejected for every visit (E & M Code 99215) by United Healthcare and AmeriHealth thru their level 1 (AI) and level 2 (non expert) reviews by OPTUM Rx.
 
FOR EXAMPLE: THESE REJECTIONS ARE ALL RELATED to PATIENTS WHO CONSISTENTLY TEST POSITIVE FOR FENTANYL / HPSOs and POLY-SUBSTANCES SURPRISINGLY STATING –  “RISK of COMPLICATIONS and/ or MORBIDITY or MORTALITY for PATIENT MANAGEMENT DID NOT MEET the LEVEL BILLED” (E & M Code 99215)! 
 
Ironically, United Healthcare and AmeriHealth, along with AmeriGroup, are the same local companies under your purview most responsible for the past years of buprenorphine “under dosing,” related treatment failures, and unnecessary Black deaths, not just noted here in Washington, but extrapolated to many states across the country
 
I am therefore requesting that you immediately investigate this current billing crisis which represents the newest, oxymoronic structural barrier to care for these highest risk patients!
 
Respectfully,
Edwin C Chapman, MD
(301) 538-1362
 
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