Self-insured companies demanding payback of 'overpayments'

Earlier this year, an Atlanta-based employer began a pilot test of a new policy, under which it asked doctors to repay what it said were overpayments. Now, it appears that it was just the beginning of what could be an emerging new approach for self-insured employers.

The self-insured company, Georgia-Pacific, hired Franklin, TN-based Health Research Insights to review its reimbursement history, then sent out 1,100 repayment requests to physicians. To make its determination that overpayments had been made, HRI runs an analysis of claims data to identify what it considers to be aberrant coding.

I bet you won't be surprised to hear that the requests didn't sit well with Georgia physicians, who went straight to the state medical association and demanded that the company stop what it was doing. After discussing things with the Medical Association of Georgia, Georgia-Pacific backed off last month.

That being said, it seems that HRI is doing similar work in Tennessee and Indiana, at minimum. Don't be surprised if other large, self-insured companies in your region try this, as well. This seems like an idea that may have some legs, like it or not.

To learn more about the repayment requests:
- read this American Medical News piece

Suggested Articles

An ACA public option could lead to lower premiums for commercial plans by sparking more competition, an analysis found.

Centene Corporation posted $95 million in profit for the third quarter of 2019, which skyrocketed from $19 million in the third quarter of 2018.

A KHN investigation found that manufacturers, hospitals, doctors and some patient advocates have put marketing muscle behind 3D mammograms.