The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) of the Social Security Act,...more
7/16/2024
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Deadlines ,
False Claims Act (FCA) ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part C ,
Medicare Part D ,
Overpayment ,
Proposed Regulation ,
Refunds
On August 17, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a bulletin (Bulletin) to states addressing potentially inappropriate cost-based proposals and practices related to governmental ambulance...more
Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more
7/19/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Health Care Providers ,
Medicare ,
Medicare Provider Agreements ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
ZPIC
A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which...more
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) on May 12, 2014 published a proposed rule (Proposed Rule) that would implement the OIG’s expanded authority under the Affordable Care...more