Meeting Archive:
Overpayment and underpayment recovery efforts

Meeting Description:

Overpayment and underpayment recovery efforts


Managed care organizations’ (MCO) overpayment recovery efforts have plagued physicians for far too long. MCOs (or the third parties that they hire to perform these recovery efforts) frequently seek refunds of payments made years in the past, of which the physician may have little, if any, records. And many refund requests provide little, if any, identifying information, such as the patient’s name or identification number, dates of service, payment amounts, the name or national provider identifier (NPI) of the physician who provided the service, etc., that would enable the physician to investigate the alleged overpayment’s legitimacy or make crucial accounting adjustments. If the physician refuses to refund the alleged overpayment, MCOs simply recoup that amount from pending or future claims. This webinar discusses state laws that protect physicians and regulate MCOs’ ability to pursue overpayments, by, for example: restricting the “look back,” period; imposing requirements that refund requests must satisfy; and limiting the circumstances under which an MCO may pursue an alleged overpayment.
Date: Tue, Nov 13, 2012
Time: 12:00 PM CST
Duration: 1 hour
Host(s): AMA Practice Management Center
 Presenter Information
Wes Cleveland, JD

Wes Cleveland is an attorney in the AMA’s Private Sector Advocacy unit. Prior to joining the AMA, Mr. Cleveland served as assistant attorney general in the Office of the Texas Attorney General, an attorney in the Texas Medical Association’s Office of General Counsel, and in private practice in Austin, Texas, where he represented physicians, hospitals, and individual and institutional health care providers.

Mr. Cleveland advocates for physicians on a wide variety of issues related to federal fraud and abuse, antitrust, the Employee Retirement Income and Security Act, and state and federal managed care requirements.