

The part that immediately got me was the clinician hiring a biller to dispute the $20k payback, only for it to be reduced to $10k. They probably paid the biller almost $10k to get the documentation together. For smaller paybacks, the clinic would probably be taking a loss to dispute the charge even if it gets stopped completely. As long as the insurer can provide justification for the charge, there’s basically no way to punish them for doing this, even when the insurer knows the original payment was legit.
Looks like a gear ratchet. Slope on the left piece allows a gear to rotate in one direction. Clamp on a bar on the right allows the assembly to be lifted to allow the gear to rotate in the other direction as well. Like a sort of gear brake?