The part that immediately got me was the clinician hiring a biller to dispute the $20k payback, only for it to be reduced to $10k. They probably paid the biller almost $10k to get the documentation together. For smaller paybacks, the clinic would probably be taking a loss to dispute the charge even if it gets stopped completely. As long as the insurer can provide justification for the charge, there’s basically no way to punish them for doing this, even when the insurer knows the original payment was legit.
The part that immediately got me was the clinician hiring a biller to dispute the $20k payback, only for it to be reduced to $10k. They probably paid the biller almost $10k to get the documentation together. For smaller paybacks, the clinic would probably be taking a loss to dispute the charge even if it gets stopped completely. As long as the insurer can provide justification for the charge, there’s basically no way to punish them for doing this, even when the insurer knows the original payment was legit.