Overpayment Recoveries by Health Insurers: Bringing and Defending Claims, Evaluating Merits, Scope of Recovery

Strafford

This CLE course will guide counsel to healthcare insurers and providers on bringing and defending overpayment recovery claims. The panel will provide practical insight from both plan and provider perspectives on implementing and dealing with health insurer audits, overpayment demands, and recoveries.

The government has focused on fighting healthcare fraud and abuse and pursuing overpayments. They are not alone in this endeavor. Health plans are also tasked with combating fraud and abuse (by contract or by their own initiative). The result is that health insurers have become increasingly more active in investigating potential provider fraud and abuse and seeking the recovery of overpayments from healthcare providers.

Both health insurers and providers must understand the regulatory framework under which claims for overpayments are brought. Further, counsel to providers should evaluate the merits of the claims and be prepared to challenge them.

Listen as our authoritative panel of healthcare attorneys provides practical insight from both plan and provider perspectives on implementing and dealing with overpayment demands and recoveries.

Outline

1. Regulatory framework
2. Key considerations
   1. Basis for recovery
   2. Merits of claim
   3. Scope of recovery
3. Best practices
   1. For healthcare providers
   2. For health insurers

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