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Healthcare Newsletter

Received recoupment request?

December 18, 2012

Question:

Dear Jennifer,

I received a few letters addressed to my practice from insurance companies in the past few weeks requesting money back.  Why now and what should I do?

Thanks,
Dr. P

Answer:

Dr. P, you are not alone.  Hordes of letters have gone out from insurance companies in the past few weeks requesting money back because we are approaching the end of the year.  Insurance companies have profit margins to meet, deadlines set for year end, inclusive of which are recoupments.  What you should do in response to receipt of a recoupment request depends on a number of factors, including but not limited to, whether the recoupment request is valid and you were in fact overpaid or paid incorrectly for services rendered (or not), your level of documentation, the way the recoupment request was calibrated, etc.  Without seeing the letter(s) and having additional facts I cannot opine on your specific scenario(s).  However, I can say with a fair amount of certainty that many of the recoupment letters sent by insurance companies cannot be substantiated and the amount(s) requested should not be blindly paid back.  Additionally, if engaged in a recoupment review/audit with an insurance company, bringing that situation to a conclusion by simply sending a check back is to miss out on the opportunity to obtain a legal release from that company for other additional potential claims. 

For a review of the requests received contact me directly (516 747 6700 x. 302) or Rachel Weinrib, Esq. of our office at 516 747 6700 x. 317 to discuss your potential exposure and how we would proceed to mitigate any such exposure for you.  Important to note, negotiations with an insurance company over a recoupment request is one of those situations where you will likely not receive as positive a result without representation by counsel, and in fact may miss an opportunity to obtain a legal release against future review.


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