• info@avym.com

Stop unauthorized overpayment refunds/recoupments



Overpayment recoupment practices typically result in refund requests deployed retrospectively (post-adjudication or post payment). Many times these result in withholding of future payments from healthcare providers for the same or even other unrelated patients. Our expertise can stop potential withholding of future payments and in many cases we can recover previously deducted reimbursements.

Have you experienced a denial?
Learn more about the recent DOL position on private payor overpayment
recoupment and how it can affect you.Contact Us Now

  • DOL Advises Court That Aetna Must Comply with ERISA for Overpayment Demands

    On November 30, 2012 the Department of Labor (DOL), filed an amicus bBrief in the Court of Appeals for the Third Circuit in support of plaintiff providers in an overpayment ERISA class action. The DOL’s position on the pertinent issues includes:

    • 1. Aetna must comply with federal law ERISA for all post-payment overpayment demands due to ERISA plan coverage dispute guidelines.
    • 2. A healthcare provider with a valid assignment has federal rights to ERISA appeals and lawsuit in federal court.
    • 3. Post-payment, retroactive, overpayment demand is an ERISA adverse benefit determination, triggering full and fair reviews guaranteed under ERISA.
    • 4. Aetna’s hypothetical state law claims of fraud may not short circuit federal ERISA procedural protections for both in-network and out-of-network providers and patients.

    Learn how AVYM can help you prevail over post-payment denials under ERISA here.

  • HEAT Provider Compliance Training

    OIG Provider Compliance Training at oig.hhs.gov