John Leardi Shares insights on Navigating Payer Contract Pitfalls in Podiatry Management Magazine
Buttaci Leardi & Werner member John Leardi was quoted throughout an article in Podiatry Management magazine titled “Common Pitfalls in Payer Contracts.” The article, published in the June/July 2025 issue, discusses seven common minefields found in payer contracts and how to navigate them.
Leardi says one little-known pitfall, or at least a greatly misunderstood one, is a contract provision that allows payers to recoup overpayments from the practice. He notes that almost every state has passed legislation regarding overpayment, but by signing the provider contract, a provider may be giving up some of those rights.
“They’re not constitutional. You can waive them. There may be language in the contracts that if the payer decides you’ve been overpaid, they reserve the right to take it out of your current claim submissions.”
Leardi says these can be very difficult to understand or negotiate around.
“With these provisions the most important piece is understanding they exist and trying to implement workflows to deal with the mayhem they can visit upon your office in terms of even just reconciling a patient account.”
Leardi also warns providers to get all the facts before signing up with a managed care entity. For example, a provider who signs up with a managed care entity to service their PPO population should be clear on whether they are also agreeing to treat their managed Medicaid patients, for whom the provider would be paid much less than for the PPO patients.
“So, understand if you are making a contract for one plan or all the plans that the payer has in place,” Leardi says. “I can’t tell you how often clients will come to me and don’t understand that by signing a commercial agreement, they’ve agreed to take on Medicaid patients. And that can cause a nightmare.”
To learn about other pitfalls providers should watch out for in payer contracts and Leardi’s guidance on how to avoid or mitigate them, read the full article “Common Pitfalls in Payer Contracts.”
The article was originally published in the June/July 2025 issue and appears with the permission of Podiatry Management Magazine. John W. Leardi represents podiatric physicians and their practices in business transactions, regulatory proceedings, and payer reimbursement disputes. He is a Fellow of and regular contributor to the American Academy of Podiatric Practice Management. He and his law firm also serve as General Counsel to the New Jersey Podiatric Medical Society.
- Posted on: Jul 8 2025