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How long after payment can payors ask for money back?

Provided by: Jennifer Kirschenbaum, Esq.

May 8, 2014

Question:

Jennifer,

How long after I have been paid by a payor do they have to ask me for the money back?  Keeps happening and want to know when the statute of limitations runs on this. 

Thanks, 

Dr. C

Answer:

Good question, and I'm sorry there is a need to address.  For NY - Private Payors have 2 years to "look back" for potential overpayments for a reason - lack of medical necessity, incorrect coding, duplicative payment - has to be some reason.  If the payor is alleging fraud or abusive billing practices the payor could go back 6 years. Medicare may look back 5 years even where the provider is "without fault". 42 U.S.C. §1395gg(b). 



If you do receive an overpayment request you believe to be the first of many or a request for an amount above several thousand dollars, be sure to consider challenging prior to refunding because the request(s) may be the start of a much larger problem - including cash flow disruption.  Contact Jennifer or Rachel to discuss the request(s) and your options.  Listserv members are never charged for a consult.

Jennifer Kirschenbaum, Esq., healthcare, doctor, physician, regulatory compliance, transactional, audit defense, licensure, litigation and general practice management matters, Jennifer@Kirschenbaumesq.com

 

JENNIFER KIRSCHENBAUM, ESQ. l  JENNIFER@KIRSCHENBAUMESQ.COM
KIRSCHENBAUM & KIRSCHENBAUM, P.C. l 200 Garden City Plz, Garden City, NY 11530
(516) 747-6700 (P) l (516) 747-6781 (F) l www.kirschenbaumesq.com


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