Health Law Alert -- March 2012 -- CMS's Proposed Repayment Rules: A Ticking Timebomb For Medicaid & Medicare Providers!


Earlier this month, the Center for Medicaid and Medicare Services ("CMS") issued a new proposed rule governing the reporting and returning of over-payments made by Medicaid and Medicare providers. While most providers know that existing law requires providers to report and return any over-payment and notify CMS (or the appropriate contractor) that the payment was, indeed, returned, CMS has, until now, provided little guidance concerning the scope of the rule.

Once a potential over-payment has been identified, a "reasonable inquiry" must be undertaken. If it is determined that the transaction does indeed represent an overpayment, the provider then has sixty (60) days to report and return the monies at issue. According to CMS, the failure to conduct this reasonable inquiry "with all deliberate speed" may give rise to liability under the False Claims Act.

Please see full alert below for more information.

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Published In: Administrative Agency Updates, Health Updates, Insurance Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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