CMS provides some clarity in Affordable Care Act final rule, but questions remain, complicating compliance efforts.

On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) published a final rule (Final Rule) implementing Section 6402(a) of the Patient Protection and Affordable Care Act (the ACA), the 2010 legislative provision requiring Medicare providers and suppliers, Medicaid managed care organizations, Medicare Advantage organizations and Prescription Drug Plan sponsors to report and return overpayments of Medicare or Medicaid funds under specific timelines. The Final Rule, which implements Section 1128J(d) of the Social Security Act (the Act), entitled “Reporting and Returning of Overpayments,” requires federal overpayments for certain healthcare services to be reported and returned by the later of: (1) 60 days after identifying the overpayment or (2) the date any corresponding cost report is due, if applicable (the Overpayment Rule).