Health Care Operations & Compliance, Professional Perspective - Best Practices for Bringing and Defending Overpayment Recoveries by Health Insurers

David Greenberg discusses best practices for health plans and health care providers in pursuing and responding to overpayment recovery demands. The article outlines key legal and practical considerations, including contractual and regulatory requirements, the factual basis for recovery, and the use of statistical sampling and extrapolation to calculate overpayments. It also provides guidance for health plans seeking to substantiate recovery claims and providers seeking to challenge them.