Starting January 1, 2026, healthcare providers in Florida will be legally required to refund patient overpayments within 30 days of identification. Under the new Florida law, this applies to any licensed facility or practitioner that submits claims to government or private insurers. Providers should begin reviewing and updating their billing and refund protocols well ahead of the deadline.
Penalties and Provider Responsibilities
Failure to issue timely refunds could result in significant penalties. Providers regulated by the Agency for Health Care Administration (AHCA) may face fines of up to $500 per day per violation. Those under the Department of Health (DOH) could risk disciplinary actions, including suspension or loss of licensure.
The law also applies indirectly to billing companies, third-party administrators, and practice groups. Even if these entities aren’t directly licensed, providers are still fully responsible for ensuring compliance. This underscores the need for clear oversight and communication with billing teams and vendors.
Limited Scope but High Risk
The law applies only to insured patients, not self-pay individuals. While patients cannot sue providers directly, they are allowed to file formal complaints with state agencies. These complaints could lead to costly investigations or enforcement actions.
The compliance risk is considerable, particularly for providers relying on manual processes or outdated billing systems. Many organizations lack formal procedures for identifying and returning overpayments. Without a solid plan in place, providers could be exposed to unnecessary regulatory consequences once the law goes into effect.
How Patriot Group Can Help
Patriot Group is already helping clients prepare for this change. As a full-service revenue cycle and compliance firm, we offer audits, process reviews, and training to ensure healthcare providers are equipped to meet state and federal requirements.
If your practice needs help preparing for Florida’s new refund rules or if you want to evaluate your current compliance posture, contact Thomas J. Force, Esq., President and Founder of Patriot Group, at [email protected] or call (631) 870-4040. We’re here to make sure your organization stays compliant and gets paid fairly.
