Definition
A clawback, or recoupment, happens when a payer audits paid claims and recovers payment for services it determines were not adequately documented or medically necessary. In ABA, the most common trigger is documentation — cloned notes, missing elements, or notes that don't support the units billed.
Clawbacks can extend across a clinician's whole panel once a pattern is found, which is why consistent, defensible session notes matter beyond any single claim.