Overpayment Recoveries by Health Insurers: Bringing and Defending Claims, Evaluating Merits, Scope of Recovery
Recording of a 90-minute CLE video webinar with Q&A
This CLE course will guide counsel to healthcare insurers and providers on bringing and defending overpayment recovery claims. The panel will provide practical insight from both plan and provider perspectives on implementing and dealing with health insurer audits, overpayment demands, and recoveries.
Outline
- Regulatory framework
- Key considerations
- Basis for recovery
- Merits of claim
- Scope of recovery
- Best practices
- For healthcare providers
- For health insurers
Benefits
The panel will review the following important issues:
- Hot trends in fraud and abuse (what are health insurers looking at), recent recovery actions and settlements, including lessons learned
- Key considerations when determining whether to bring recovery claims and defending against such claims
- Best practices for challenging health insurer audits, sampling, and extrapolation evidence
Faculty
Lisa Gallagher
Assistant General Counsel
CareSource
Ms. Gallagher is an experienced nurse-attorney with a diverse background in healthcare, litigation, investigations, and... | Read More
Ms. Gallagher is an experienced nurse-attorney with a diverse background in healthcare, litigation, investigations, and executive leadership. Since 2018, she led Fraud, Waste, and Abuse (FWA) efforts, then litigation management at Commonwealth Care Alliance, continuing in this role following its 2025 acquisition by CareSource. She previously held senior legal roles at the Insurance Fraud Bureau of Massachusetts and the Investigations Division of the Massachusetts Department of Mental Health. Ms. Gallagher is a Certified Fraud Examiner (CFE) and Certified Professional in Patient Safety (CPPS) and has also served as adjunct faculty at MCPHS University.
Close
David S. Greenberg
Partner
ArentFox Schiff
Mr. Greenberg advises health care companies, including providers and suppliers, through an exceedingly... | Read More
Mr. Greenberg advises health care companies, including providers and suppliers, through an exceedingly complex and volatile regulatory environment. He focuses his practice on counseling health care clients on regulatory issues related to the Affordable Care Act, the False Claims Act, the Anti-Kickback Act, the Stark Laws, state licensure, self-disclosures, reimbursement and payment, and participation in Medicare, Medicaid, and other government health care programs.
Close