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Correcting Medi-Cal Overpayment Issues

If you have read our previous post on Medicare overpayments, then you know how complicated the process can be. The same applies to Medi-Cal overpayment issues. Healthcare providers who accept this public health insurance program may encounter discrepancies or overpayment concerns, which are almost inevitable in large organizations.

Fortunately, our team of attorneys — who specialize in Medicare/Medi-Cal audits, appeals, and overpayment disputes — is here to help set things straight. Take a look below for all the information you need about correcting Medi-Cal overpayment issues.

What Are Medi-Cal Overpayments?

Medi-Cal overpayments occur when healthcare providers receive funds exceeding the amount they are legally supposed to be given under the program’s guidelines. These overpayments can happen for a variety of reasons, including billing or administrative errors, unreported income, incorrect coding, and changes in patient eligibility.

Since these excess funds are issued by mistake, the Department of Health Care Services (DHCS) is responsible for getting back the overpaid amounts from providers or beneficiaries to ensure compliance with Medi-Cal regulations.

Am I Responsible for Returning an Overpayment?

The short answer is yes. Healthcare providers are legally required to report and return any Medi-Cal overpayment within 60 days of becoming aware of the mistake. Failing to do so can result in serious consequences, including potentially violating the False Claims Act, which could lead to fines, exclusion from the insurance program, or legal action for healthcare fraud. 

The DHCS also regularly audits providers to look for overpayments. If the overpayment is discovered through the audit before the provider self-reports it, the consequences could be even worse.

How to Correct a Medi-Cal Overpayment

Consider taking the following steps if you encounter an overpayment issue:

1. Consult an attorney who specializes in overpayment recovery. They can help make sure you are maintaining compliance, and guide you through the repayment or appeals process.
2. Review billing records. Carefully look over claims, statements, and patient records to double-check that an overpayment occurred. 
3. Confirm the overpayment amount. Determine the exact overpaid amount. Compare the billed amount with what Medi-Cal or a managed care plan paid or look for duplicate payments or other mistakes.
4. Determine the cause of the error. Check if the issue is due to wrong coding, double billing, changes in patient eligibility, or another reason.
5. Report and return the overpayment within 60 days. California and federal laws expect providers to return overpayments within 60 days of discovering the error.
6. Submit the repayment to DHCS or the proper managed care plan. Fee-for-service Medi-Cal overpayments are repaid to the DHCS, while managed care plan overpayments must be repaid directly to the respective plan. 
7. Appeal if necessary. If you think the overpayment was incorrect, you can appeal through the Medi-Cal administrative review process. Contact an attorney experienced in Medi-Cal overpayment disputes to help you through the appeals process.

To prevent overpayments in the future, we suggest auditing your billing practices regularly. Also, keep up with the latest health insurance laws. Our lawyers who specialize in Medi-Cal/Medicare overpayment can help you every step of the way.

Speak to a Specialized Attorney About Medi-Cal Overpayments

At Fenton Jurkowitz Law Group, our team of seasoned healthcare law attorneys specializes in Medicare/Medi-Cal audits, appeals, and overpayment disputes. With extensive experience, we handle the process of correcting Medi-Cal overpayment issues and help alleviate the stress involved. Connect with one of our attorneys today by filling out the contact form on our website.