New Florida Patient Refund Requirement for the New Year
It's a familiar scenario: A patient visits the doctor and is prepared to pay, only to be told that the doctor will just apply money being held in the patient's account to the amount the patient owes. Perhaps at a previous visit the patient paid a deductible, but after the provider submitted the claim to insurance, it turned out that the patient had been charged unnecessarily. These kinds of overpayments can happen for a variety of reasons, including coding errors, insurance coverage adjustments and simple mistakes. In response, Florida passed new laws in 2025 that make it unlawful for licensed healthcare facilities and practitioners to hold on to money that a patient paid but did not owe.
Beginning Jan. 1, 2026, under Section 408.12, Florida Statutes, Florida healthcare facility licensees, including hospitals, nursing homes, assisted living facilities, laboratories and other licensed entities that file claims for reimbursement with any government-sponsored or private health plan or HMO, must refund any overpayment to the patient no later than 30 days after the date that the licensee determines that the overpayment was made. Under Section 408.813(3)(g), Florida Statutes, licensees can be subject to a fine of up to $500 per violation. A similar law (Section 456.0625, Florida Statutes) applies to healthcare practitioners, including physicians, pharmacists, dentists, and other providers and their billing departments, management companies and group practices, but with much more serious potential penalties for the licensed practitioners. Healthcare practitioners that do not provide the required refunds within 30 days of the overpayment determination can be subject to disciplinary action under Section 456.072(2), Florida Statutes, including licensure denial, suspension, fines of up to $10,000 per offense, issuance of a reprimand or letter of concern, probation and other penalties.
It is important to note that the new refund requirements do not apply to overpayments made by a health insurer or HMO. Existing laws regarding overpayments apply to those amounts. As Florida healthcare providers and facilities start the new year, updating policies and procedures to comply with these new laws should be an important addition to their existing compliance programs.