Patient overpayment laws

Texas Occupations Code § 101. How long does a patient have to pay overpayment? If a patient pays more than they are required to, the patient must be notified as soon as the overpayment is discovered. The practice has a couple of options on how to handle the overpayment , but the provider cannot legally hold on to the money indefinitely.

What is an overpayment provider?

Let’s say a patient came in for an office visit and paid a co-pay. We all make mistakes, but either deliberately or unintentionally withholding overpayment holds legal consequences. Processing and returning overpayments is not optional.

If a patient overpays a physician, the physician must refund the amount of the overpayment not later than the 30th day after the date the physician determines that an overpayment has been made. Collecting from patients at the front desk can result in patient overpayment. Overpayments must be returned when they are “identified” 1. Also, some managed care contracts specify that you must process refunds for overpayments within a specific time period.

Healthcare providers are also subject to abandoned property laws , which are pertinent in determining patient refunds.

If an audit later uncovers an additional overpayment , the full amount shall be repaid within days unless the provider submits further documentation supporting a modification to the existing extended repayment schedule to include the additional amount. A primary source of these protections is the Employee Retirement Income. These overpayments may be the fault of either.

Medicaid overpayments to the State agencies. Failure to pay or deny overpayment within 1days after receipt creates an uncontestable obligation to pay the claim. It also gives instructions on how to request a payment plan.

If I was in your position, I would mention that the funds are to paid to you immediately, or you would be looking to file a complaint with the state dental board mentioning that keeping an overpayment is a frau and could also be a criminal action, especially if they used mail to bill insurance company. Other than recovery for duplicate payments, a health plan shall provide thirty days written notice to health care providers before engaging in additional overpayment recovery efforts seeking recovery of the overpayment of claims to such health care providers. When the provider files a cost report indicating that an overpayment has occurre full refund shall be remitted with the cost report.

In cases where DMAS discovers an overpayment during desk review, field audit, or final settlement, DMAS shall promptly send the first demand letter requesting a lump sum refund. As a courtesy, the doctors bill the insurance carrier and are paid directly for covered treatments, and they bill the patient for the co-pay amount, which is paid at the time. The primary function is to recover funds due the Medi-Cal program, thereby reducing the total cost of the program. No statute or regulation explicitly requires refund of overpayment to the government – Except for Stark Law regulations, CFR 411. This resource, Knowing your overpayment recovery rights (PDF), offers information on the responsibilities of health plans and the rights of physicians provided by many states laws and regulations.

It is intended to ensure that physicians understand their rights in the overpayment recovery request process. Other healthcare providers implemented patient -friendly customer service policies to address patient overpayments as well as issue refunds when requested by the patient.

Like sharks smelling blood in the water, states became aware of the gold mine of credit balances sitting in many health systems computer bases. If a patient has overpaid the amount due to the hospital or ambulatory surgical facility, whether as the result of insurance coverage, patient error, health care facility billing error, or other cause, and the overpayment is not in dispute or on appeal, the hospital or ambulatory surgical facility shall provide the patient with a refund. An overpayment may also be offset or intercepted by the Department of Revenue and applied to another liability. However, often an overpayment is refunded directly to you.

A: The amount of the monetary penalty is calculated based on the amount of overpaid benefits. If the willful overpayment is $666. Please select a topic from the list below to get started. OVERPAYMENT DEFINITION.

A Medicare overpayment is a payment that exceeds regulation and statute properly payable amounts. When Medicare identifies an overpayment , the amount becomes a debt you owe the Federal. Carriers generally issue a request for refunds as soon as they become aware of an overpayment.

Each state has an escheat law that directs how your practice should handle refunds to the payers or patients. Failure to comply with the timely investigation of overpayments exposes the practice to considerable risk. Federal wage laws give employers a lot of leeway to make deductions for inadvertent overpayments to employees.

Under the Federal Labor Standards Act (FLSA) - the federal law governing wage and hour issues - employers can deduct the full amount of overpayments to employees, even if doing so would bring the employee’s wages below minimum wage. A state’s law generally differs in the treatment of overpayments where the claimant is not at fault and overpayments due to willful misrepresentation, concealing material facts, or fraud.