Mich. Admin. Code R. 418.10120 - Recovery of payment
Rule 120.
(1)
Nothing in this rule shall preclude the recovery of payment for services and
bills which may later be found to have been medically inappropriate or paid at
an amount that is more than the maximum allowable payment.
(2) If the carrier makes a request to the
provider for the recovery of a payment within 1 year of the date of payment and
includes a statement of the reasons for the request, then the carrier may
recover a payment. The carrier may recover a payment made by an employee or the
carrier.
(3) Within 30 days of
receipt of the carrier's request for recovery of the payment, the provider
shall do either of the following:
(a) If the
provider is in agreement with the request, then the provider shall refund the
payment to the carrier.
(b) If the
provider is not in agreement with the request, then the provider shall supply
the carrier with a written detailed statement of the reasons for its
disagreement, together with a refund of the portion, if any, of the payment
that the provider agrees should be refunded.
(4) If the carrier does not accept the reason
for disagreement supplied by the provider, then the carrier may file an
application for mediation or hearing as provided for in
R 418.101303 and
R
418.101304. Within 30 days of receipt of the
provider's statement of disagreement, the carrier shall file the application
for mediation or hearing with the workers' compensation agency and the carrier
shall mail a copy to the provider.
(5) If, within 60 days of the carrier's
request for recovery of a payment, the carrier does not receive either a full
refund of the payment or a statement of disagreement, then, at the option of
the carrier, the carrier may do either or both of the following:
(a) File an application for mediation or
hearing and mail a copy to the provider.
(b) Reduce the payable amount on the
provider's subsequent bills to the extent of the request for recovery of
payment.
(6) If, within
30 days of a final order of a magistrate, the appellate commission, or the
courts, a provider does not pay in full any refund ordered, then the carrier
may reduce the payable amount on the provider's subsequent bills to the extent
of the request for recovery of payment.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.