Medicare Confirms Requirement to Return Overpayments Within 60 Days

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On February 14, 2012, the Centers for Medicare and Medicaid Services ("CMS") published a proposed rule implementing the requirements of the Affordable Care Act requiring Medicare providers and suppliers to report and return Medicare overpayments by the later of 60 days after the date on which the overpayment was identified, or the date any corresponding cost report is due. Failure to identify, report and return the overpayment within the 60 day deadline constitutes a false claim under the False Claims Act, which subjects the provider or supplier to additional penalties under thelaw.

Section 6402 of the Patient Protection and Affordable Care Act ("Affordable Care Act") establishes a new section of the Social Security Act entitled "Reporting and Returning of Overpayments." The law requires a person who has received an overpayment from Medicare or Medicaid to report and return the overpayment to the Secretary of Health and Human Services, the State, an intermediary, a carrier, or a Medicare contractor (as appropriate) and to notify such party in writing of the reason for the overpayment. Although the provisions of the statute are self implementing and thus already in effect, the proposed rule published this week (which for now applies only to Medicare Part A and Part B providers and suppliers), gives providers additional detail on the procedures for returning the overpayments, including establishing a mandatory "self-reported overpayment refund process" ("SORP")...

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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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