Don’t sit on those patient credits. Effective January 1, 2026, a new Florida law (CS/CS/SB 1808) requires licensed health care facilities, providers, and practitioners (each, a “Licensed Provider”) to refund any overpayment made by a patient no later than 30 days after the Licensed Provider determines that the patient made an overpayment.
AHCA
For Licensed Providers who are licensed by AHCA, a violation of the requirement to timely refund a patient’s overpayment is subject to an administrative fine of up to $500 per violation. Under pre-existing law (section 408.813, Florida Statutes), each day of violation constitutes a separate violation and is subject to a separate fine. As such, large administrative fines could accrue each day that overpayments are not timely repaid to patients.
DOH
For Licensed Providers who are licensed by the Department of Health (“DOH”) or one of the licensing boards within the DOH, a violation of the requirement to timely refund a patient’s overpayment is grounds for disciplinary action (e.g., administrative fines or the restriction, probation, suspension, or revocation of a license) by the applicable board or the DOH when there is no board.
Entities Associated With Licensed Providers
This requirement also applies to any billing department, management company, or group practice (each, a “Billing Entity”) that accepts payment for services rendered by the Licensed Provider. While a Billing Entity itself may not be subject to the jurisdiction of the DOH or the applicable board, the treating Licensed Provider would be subject to discipline. It will be interesting to see how the DOH implements this power with respect to Licensed Providers employed by large Billing Entities when they have little to no control over processes and procedures for patient billing and collection.
Limitations
It is important to note the limitations of this new law. For example:
- There is no private right of action, so patients cannot sue Licensed Providers for violations. However, a patient could file a complaint with AHCA or the DOH about an overdue refund from a Licensed Provider. In turn, AHCA or the DOH could investigate the complaint and impose fines or disciplinary action.
- The new law does not apply to overpayments made by a health insurer or health maintenance organization (“Payor”) to a Licensed Provider for services rendered to an insured or subscriber. Florida’s insurance laws govern those payments (sections 627.6131 and 641.3155, Florida Statutes, respectively).
- The new law closes the loophole left by the insurance laws referenced above that protect Payors from overpayments, but not the patients who often pay a portion of the bill as part of their deductible, copay, or coinsurance. The new law only applies when a patient is due a refund from a Licensed Provider who filed a claim with a Payor or government-sponsored program (e.g., Medicaid, Medicare, and TRICARE) for reimbursement for the services rendered to the patient. So, while the new law does not protect the Payor or government program, their involvement is required to the extent the claim for the service for which the patient overpaid must have been submitted by the Licensed Provider for reimbursement by such Payor or government program. The law does not apply, however, to overpayments made by uninsured, self-pay, or cash pay patients.
Licensed Providers (and their Billing Entities) should review their revenue cycle management processes and procedures to ensure that overpayments made by patients are consistently repaid within the 30-day period. Akerman can assist Licensed Providers in interpreting how this new requirement applies to them.