The withholding by commercial and governmental payers of proper reimbursement for the provision of healthcare services, based on allegations of improper billing or fraud, continues to be a major financial hurdle facing healthcare providers. For instance, New York Insurance Law § 3224-b allows commercial health plans to provide no more than 30 days written notice to physicians before engaging in “overpayment recovery efforts,” which can be justified after they “suspect” fraud, intentional misconduct, or abusive billing.
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