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LEGAL UPDATE
In our view, as health law attorneys, an insurance carrier that has
explicitly agreed to the billing of office-based surgery facility fees and
that has continually paid such fees without objection, where full disclosure of the accreditation status of the facility has been made, has
no legal grounds to seek repayment of claims already paid to
providers who relied upon this agreement in submitting claims for
facility fees.
However, it remains a weighty decision for every physician who
receives such a notification letter from an insurer — challenge the
demand, or simply seek to negotiate some form of reduced amount?
Considering the amounts being demanded, this decision may be a
foregone conclusion. OSM
Mr. Levy (mlevy@drlaw.com) is a partner in the Westbury, N.Y., office of Kern
Augustine Conroy & Schoppmann, a law firm devoted to the representation of
healthcare professionals.
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