Menu
Button: Make a Payment Button: Newsletter Mailing List

Icon: Healthcare LawHands-On Experience

Providing legal advice

and services since 1977

Healthcare Newsletter

Should I send in records requested by an insurer?

July 26, 2011

Question:

Jennifer,

I received a request for 28 patient records from an insurance company that I was already reimbursed by for the requested services. Should I send them in?

Thanks, Dr. R

Answer:

Whether you should send the records in absolutely depends on your specific circumstances and you should work with a healthcare attorney to devise a strategy when responding to any such request. That being said I will provide some general comments - Insurance companies are entitled under NYS law to review claims already paid for a period of 2 years after payment (6 years if there is an allegation of fraud). However, the insurer is required to adhere to other relevant statutes when requesting additional documentation for review. This is relevant because NYS has privacy laws that are more prohibitive than HIPAA. So, while the letter request you have received may cite HIPAA and state that the insurer is entitled under HIPAA to receive additional records, the insurer may, in fact, not be entitled to receive additional documentation under the more protective NYS laws. Under the relevant provisions in the Public Health Law, a contemporaneous release for records is required, and any request must be narrow and specifically tailored. Therefore, a general request for records on 28 patients may not adhere to the NYS requirements, and you may be in violation by sending the records in. Patient privacy is one of the many areas you need to take into account when responding to a request.

Here, it sounds as though you have been selected by the insurer for a "post-payment" audit. (Be advised that in almost all cases of a post-payment review, I have seen the practitioner receive a "recoupment demand" for money to be returned to the insurer post-audit.) In order to better position yourself should a recoupment demand be headed your way, be sure that you do not wait until after you have sent the records in to contact competent counsel - failing to do so may put you at a significant disadvantage.

 

Copyright © 2011 by Kirschenbaum & Kirschenbaum, P.C.

All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.

 


Looking for the KK Healthcare Exchange?  Click Here. 

MISSED OUR RECENT WEBINARS?  CLICK HERE ANYTIME!
Looking for HIPAA and compliance forms?  
Click here to visit our website.
Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.
Interested in having Jennifer speak at an event or
at a residency/fellowship program?
Contact Jennifer directly at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com
Click here to learn about
K&K's Prepaid Legal Audit/Investigation Defense Now!