Provided by: Jennifer Kirschenbaum, Esq.
May 8, 2014
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.
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. 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