United to Withdraw 3,000 Overpayment Requests
[Posted 07/21/08]

United Healthcare, at CMA’s urging, has agreed to withdraw nearly 3,000 overpayment requests recently sent to physicians. Beginning in April 2008, CMA began to receive complaints from physicians regarding notices they had received from Johnson & Rountree, a recovery company hired by United Healthcare to recoup alleged overpayments made to physicians. In some circumstance, the notice erroneously identified the patients as Secure Horizons enrollees when in fact they were PacifiCare Signature Options PPO patients.

The examples provided by physicians included requests for refunds for dates of service in 2004, 2005, and 2006. California law clearly states that insurer requests for refunds must be made within 365 days of the date of payment on the overpaid claim.

To further confuse the issue, the letters from Johnson & Rountree were labeled “second request” and incorrectly stated that Johnson & Rountree had previously attempted to contact the physician regarding the overpayment.

CMA’s Center for Economic Services intervened to resolve the individual physician complaints. In each case, United acknowledged that the refund requests were sent in error. CMA continued to pressure United to investigate this issue and to fix any underlying systemic issues. Ultimately, United determined that nearly 3,000 erroneous overpayment requests were made for claims with dates of service from January 2004 to June 2007. Efforts to recover these alleged overpayments have been canceled and affected physicians will soon receive closure notices from PacifiCare.

CMA has also brought this issue to the attention of the Department of Insurance and urged them to investigate.

Click here to read CMA's letter to DOI on this issue.

Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.