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How to Defend Against Recoupments, Repayment Demands and SIU Audits.

By - Thomas J. Force, Esq.

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We will provide strategies to defend demands by insurers and health plans who seek refunds due to retroactive denials based upon a variety of reasons including medical necessity and fee forgiveness. We will discuss audits and refund demands grounded in state as well as federal law. Appeal drafting will also be discussed.


  • What is a recoupment and reason it is usually commenced by an insurer Special Investigative Unit (“SIU” Unit).
  • Explain how a defund demand is nothing more than a retroactive denial and reasons that is important.
  • The specific information that an auditor is required to include in a refund demand or rercoupment request.
  • Discuss Cross-Plan offsetting and how to stop health plans and auditors from using this tactic.
  • Provide summary of state and federal law governing refund demands and overpayment request by insurers and health plans.
  • Appeals drafting techniques will be discussed.
  • The difference between commercial insurer versus Medicare refund requests will be explained.
  • Basic ERISA Health Plan obligations will be discussed and explained reasons this is important with respect to refund demands by health plans and insurers.


Audience will learn how to object and appeal refund demands, audits and recoupment demands from health plans and insurers which can save the healthcare practitioner hundreds of thousands of dollars in potential repayments.

Who Should Attend:

Healthcare providers and their revenue cycle staff, medical practices office managers and billing staff, healthcare compliance attorneys and consultants

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Speaker Detail

Thomas J. Force, Esq.

Thomas J. Force is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group. Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students. Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations. On March 29th, 2022, Thomas J. Force, J.D, Esq, President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section. For more information on this forum, please email Mr. Force.

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