Most states limit how far back an insurer can recoup, but the exceptions (fraud, coding, self-funded plans) decide these cases. Check your state's limit, then turn the letter into a dated response plan.
Check my state's limit →Free, no sign-up.
How far back an insurer can recoup in your state, its exceptions and the statute, checked against the code and dated. Free.
Which dates in the letter you can't miss, what an appeal needs, and when it's time to bring in a healthcare attorney.
Send the auditor's letter with client details removed. You get back a checklist of what was requested, a cover-letter draft and the questions to ask. Your records stay with you.
“They looked at 140 progress notes across 3 years of claims billed under my NPI … It was determined to have a 97% compliance fail rate, and they are demanding $551,000 back from me in 20 days.” (public r/therapists post, Jan 2026)
“I received a letter from UHC stating that I bill 90837s more frequently than the average clinician and that they are essentially monitoring my billing patterns.” (public r/therapists post, Aug 2026)
Had this happen recently? Tell us what happened (4 questions, about 10 minutes, no sign-up).
Legal information, not legal advice; for a large demand or a fraud allegation, use a healthcare attorney. The state table stays free.
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Part of Ops Fixes: free checks and fix guides for small teams.