DOJ, NY AG REACH SETTLEMENT WITH HOSPITALS IN LANDMARK 60 - DAY RULE CASE -

On August 24, 2016, the U.S. attorney for the Southern District of New York and the New York State attorney general announced a $2.95 million settlement (Settlement) in U.S. ex rel. Kane v. Continuum Health Partners, Inc., et al., the first publicly unsealed federal False Claims Act (FCA) case against a health care provider for allegedly violating the 60-Day Rule.

The 60-Day Rule—enacted in 2010 as part of the Affordable Care Act—requires a health care provider that receives an overpayment to report and return the overpayment by the later of (1) 60 days after the provider identifies the overpayment or (2) the date any corresponding cost report is due. An “overpayment” includes any Medicare or Medicaid funds received that the provider is not entitled to retain after an applicable reconciliation. Failure to report and return an overpayment within the 60-Day Rule’s time frame subjects a provider to liability under the FCA, including treble damages and civil penalties.