New Florida Law Requires Timely Refunding of Patient Overpayments
Retaining patient overpayments just got riskier for physicians in Florida. Effective January 1, 2026, new legislation imposes requirements on licensed healthcare providers and facilities regarding patient overpayments. Under CS/CS/SB 1808, licensed practitioners are required to refund any overpayments made by patients within 30 days of determining that a patient overpayment was made. Violations of this legislation may result in administrative fines and/or disciplinary action.
Patient overpayment occurs when a patient pays more for a healthcare service than they are obligated to pay, or when the patient pays for a service for which the provider later receives full or partial reimbursement from a third-party payer (e.g., an insurer). Overpayments can occur for a variety of reasons, including duplicate charges, coding errors, insurance reconciliation adjustments, and errors in the billing process. The 30-day timeline to refund the overpayment begins once the provider “determines” that an overpayment was made. Although there is no guidance regarding what a “determination of overpayment” means, several mechanisms would likely trigger the 30-day clock. For example, any internal accounting report identifying the overpayment would almost certainly trigger the 30-day clock.
Notably, the new legislation applies only to overpayments owed to the patient when the provider has submitted a claim for reimbursement to a government program (e.g. Medicare, Medicaid, Tricare), a private health insurer, or a health maintenance organization. The legislation explicitly states that it does not apply to overpayments made to health care providers by commercial health insurers and health maintenance organizations, which are already covered under Florida insurance law. Also excluded from this legislation are overpayments for services that were not billed to an insurer, such as payments made by uninsured or self-pay patients, or for services not covered by insurance.
Failure to comply with the new legislation could lead to significant penalties and fines. Providers regulated by the Agency for Health Care Administration (AHCA) may face fines of up to $500 per day (per violation) for withholding patient refunds. Each day of a violation may incur its own $500 fine, which means large administrative fines could accumulate very quickly for non-compliance. In addition, providers licensed by the Florida Department of Health could face disciplinary action, including suspension or loss of license. While patients may not sue a provider directly for a violation, they may file a complaint with the Florida Department of Health or the AHCA.
Compliance Tip
Licensed providers and their billing departments should have clear policies and processes in place to ensure that patient overpayments are identified and promptly refunded in accordance with this new legislation.
For more information on this topic, contact Suzanne Castaldo, JD ([email protected]).
