Fighting Back Against Repayment Demands and Offsets

In their article, “Fighting Back Against Repayment Demands and Offsets,” Zuckerman Spaeder LLP partners D. Brian Hufford and Jason S. Cowart address the common and highly profitable health insurance practice of recoupment, where an insurer retroactively denies a care provider’s previously paid claim and then demands repayment. Mr. Hufford and Mr. Cowart point out that insurers regularly seek to recoup alleged overpayments when there is no allegation of provider fraud, provider error, and no way for the provider to challenge the insurer's determination. They go on to review the growing legal case against recoupments and, highlighting their own recent trial victory against an insurer’s recoupment effort, discuss how providers may be able to effectively challenge this practice under ERISA.