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Daniel Kokhba
Daniel Kokhba,
Category: Business Law
Satisfied Customers: 1739
Experience:  Partner at Kantor Davidoff
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I need help with fighting tricare over recoupment They had a

Customer Question

I need help with fighting tricare over recoupment They had a glitch in the system that allowed them to pay what was billed for care provided to clients. They are now asking for money back due to their error (Humana Tricare)
JA: Have any documents been prepared or filed so far?
Customer: By me? I have sent in a couple of documents asking them to review the case. They have all been dismissed and they say I owe EVEN though it was their error and other Tricare companies have cancelled any efforts to recoup these funds from providers across the country
JA: Because laws vary based on location, what state are you in?
Customer: Texas
JA: Anything else you want the lawyer to know before I connect you?
Customer: No maak no maam
Submitted: 9 months ago.
Category: Business Law
Expert:  Richard - Bizlaw replied 9 months ago.

Hello, my name is ***** ***** I will try to help you. Please remember I just report or interpret the law, so the outcome may not be what you hoped for.

Did they pay for services that you were obligated to pay? During what period of time did this improper billing take place? What does your agreement with them say about billing errors and the period during which they have to recoup them?

Customer: replied 9 months ago.
Hello Richard,
Short story: a billing company I used billed Tricare for services I performed. I received the funds from Tricare and I wrote checks to clients reimbursing them what they were supposed to receive. I later learned there is a maximum allowable amount one can bill Tricare for services (unknown to me) but due to a glitch in their system it allowed payment for what I billed to go through. The error is with Tricare Humana (they operate the Tricare south region billing and payments). This same issue occurred in the north (Healthnet) however they realized their error and dropped the recoupment attempts that were placed against certified nurse midwives in that area.
They mentioned they were looking at improper payments going as fatback as six years or more. I am an out of network provider so I have no obligation to bill what they say. Here is some information about the North case:
Expert:  Richard - Bizlaw replied 9 months ago.

This is charge that your customers should have paid and not you, is that correct? By that I mean if they problem had been caught immediately you would have been notified and you would have notified the customer that a portion of the bill they had to pay themselves is that correct?

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