October 18, 2018
Area(s) of Interest: Practice Management Public Payors
Between June and August of this year, L.A. Care issued a large number of overpayment requests to physicians. According to L.A. Care, it was requesting refunds on overpaid Medi-Medi claims. However, some of the requests were for very old claims, dating back to 2012. The California Medical Association (CMA) raised concerns with L.A. Care about the timeliness of some of the refund requests, as California’s Knox Keene act limits plans’ ability to request refunds to 365 days from the date of payment, except in cases of fraud or misrepresentation.
After review, L.A. Care rescinded the overpayment requests on claims that were non-compliant with the 365-day timeframe. L.A. Care is also refunding payments already made by physicians or payments that were automatically recouped by L.A. Care on claims older than 365 days. Any physician appeals contesting the 365-day timeframe will be closed.
However, for claims paid within 365 days from the date of the overpayment request, L.A. Care still expects reimbursement. In the letters, L.A. Care states it will provide physicians with an updated list of claims it is pursuing for recoupment within the 365-day time period within the next 45 calendar days. Physicians will have 60 calendar days from the date of the re-issued overpayment notices to refund L.A. Care. Failure to do so will result in automatic recoupments.
Physicians with questions can contact Gladys Oswell, Payment Integrity Unit at email@example.com or CMA’s Reimbursement Help Line at (888) 401-5911 or firstname.lastname@example.org.