Section 418.10120. Recovery of payment.

(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.

History: 1998-2000 AACS; 2005 AACS.