Refund Demands & Offsets

The Gibson Firm represents providers-clients that provide invaluable medical services and expect appropriate payment in return. These providers typically submit timely, accurate, “clean” claims, and receive proper reimbursement. Yet, they still receive refund demands from payers for that same appropriate care that received proper payment. Refund demands are often used by payers as a business strategy to increase profit and cash flow, while appearing to have properly reimbursed for services rendered. Even when a payer may have had a potentially valid reason to deny treatment prior to services being rendered or even prior to payment of the claim, once the payment is made, a provider is generally entitled to retain voluntary payments already made under laws of restitution and equity, as well as state and federal laws — unless doing so would result in the provider receiving more than billed charges or over the contractual amount for services provided. 

Refund demands are further complicated by the payer’s ability to offset the amount of the refund against future amounts owed to the provider. TGF works swiftly and aggressively to halt refund demands and suppress offset efforts until disputes can be resolved. Offsets wreak havoc on accounting systems and require skillful defense to avoid both lost revenue and increased accounting costs.

  • TGF takes an aggressive approach to these improper and wrongful demands, and works to prevent recoupments before they happen
  • TGF defends refund demands to protect providers’ rights to retain funds voluntarily paid for services provided
  • Often, refund demands and recoupment activities are based on unlawful or incorrect retro-denials­­­––TGF routinely obtains retractions and cessation of collection efforts
  • Even when a payer has a legitimate reason to deny a claim, the provider is usually entitled to keep voluntary payments under the law
  • Recoupments create accounting nightmares that cost providers a great deal of time and money—TGF does the work for you, freeing your staff, thereby increasing your bottom line