QUESTION #851: What is the time limit that third-party payors and Medicare have to request a refund from payments that we received?

ANSWER (03/03/2009): Health plans (HMOs, Blue Cross of California PPO, and Blue Shield of California PPO) can only go back 365 days from the date of the last action of the plan. The federal government (Medicare) can go back as far as they want, particularly if they suspect fraud. Thus, there is no time limit for Medicare to request a refund.

REFERRAL: CMA Center for Economic Services, (888) 401-5911

CMA ON-CALL: #0135, “Plan Requests for Refunds From Physicians” — available free to members at http://www.cmanet.org.