Big Bills Lead Medicaid Insurer to Suspend Payments to Controversial Portland Behavioral Health Clinic

WiiCare, the behavioral health clinic that houses clients in residential homes across the Portland metro area, is losing its primary source of funding. WW profiled the new clinic, and its surprising business model, earlier this year.

CareOregon, the state’s largest Medicaid insurer, tells WW it has suspended payments to the company. “Routine claims analysis identified that WiiCare’s cost and utilization patterns were significantly higher than similar organizations,” says spokeswoman Cori Schleiffer.

CareOregon did not say in its statement exactly what those cost and utilization patterns were, but according to state records obtained by WW, WiiCare was pulling in over $400,000 a month from Medicaid this summer.

WiiCare says the big bills were due to the complexities of treating clients fresh off the streets.

“While we have submitted additional information to assist CareOregon in understanding the factors that contribute to high utilization for people who are unhoused and struggling with a variety of physical and mental health challenges, they have informed us that their decision to cease reimbursements is final,” said the company’s attorney, Patrick Smith, in a statement to WW.

Smith says the clinic is shifting its clients to another Medicaid insurance network.

WiiCare attracted the ire of neighbors and scrutiny from regulators after it moved a dozen people into one of several sober living homes its investors had acquired, this one in the East Portland neighborhood of Wilkes. The people had been recruited off the streets with promises of shelter and were bused daily back to a clinic on Sandy Boulevard where WiiCare provided treatment for substance use disorder. The clinic, but not the house, was registered with the state, and the organization appeared to be operating in a regulatory gray area.

Now, following WW’s reporting, regulators are catching up. The Oregon Health Authority told the company it needed proper permits in August.

WiiCare has now applied for those permits and, according to an inspection report provided to WW by OHA, is currently addressing various other issues uncovered, including overcrowding, a lack of basic fire safety precautions, and insufficient stores of food and water.

“They’ve submitted the application and their corrections for the findings in the report; both of those are currently under review,” said OHA spokeswoman Amy Bacher.