Proposed Rule: Reporting and Returning of Overpayments



On February 16, 2012, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement Section 6402(d) of the Patient Protection and Affordable Care Act (Affordable Care Act) which addresses the identification, reporting, and refunding of certain overpayments (the Proposed Rule). In this Alert we outline several key provisions of the Proposed Rule as well as important questions raised by CMS’s approach to these provisions. It is important to recognize that this is only a Proposed Rule, and as such CMS may change certain provisions in any final rule. We will delve into the Proposed Rule in even greater detail during a Roundtable which King & Spalding (K&S) will host on March 9, 2012.


Since the enactment of the Affordable Care Act in March 2010, providers and suppliers have been grappling with multiple issues emanating from Section 6402’s overpayment reporting and refunding requirements, including the issue of when an overpayment is “identified” for purposes of timely satisfying the refunding and reporting requirements. In the Proposed Rule, CMS attempts to clarify the manner in which providers and suppliers are expected to navigate the reporting and refunding requirements outlined in Section 6402 of the Affordable Care Act; however, as detailed below, the Proposed Rule not only fails to address certain questions that were expected to be resolved in this Proposed Rule, but also creates new questions and concerns for the provider and supplier communities.

Please see full alert below for more information.

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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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