Overpayment

News & Analysis as of

Medicaid Managed Care Update: Program Integrity Proposals Include Mandatory Reporting of Overpayments by Medicaid Managed Care...

CMS seeks to impose more rigorous program integrity requirements for contractors and states. This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more

Sixty Days of Gray: Medicare and Medicaid Refund Requirements - Hospital Industry Viewpoint

Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more

Supreme Court to Hear Arguments Involving a Health Plan’s Right to Recover Plan Overpayments

While public attention is currently focused on the upcoming high profile Supreme Court decision in King v. Burwell (which involves subsidies for exchange-based coverage under the ACA), the Supreme Court recently decided to...more

Locke Lord QuickStudy: IRS Changes Retirement Plan Correction Program (EPCRS)

The Internal Revenue Service (IRS) recently issued two revenue procedures that modify the Employee Plans Compliance Resolution System (EPCRS). EPCRS sets forth the various correction programs and correction methodologies for...more

IRS Provides New Flexibility to Correct Retirement Plan Errors

The IRS recently issued important updates to its Employee Plans Compliance Resolution System (EPCRS). The updates are contained in Revenue Procedures 2015-27 and 2015-28. ...more

In Pursuit of Benefit Plan Overpayments

Benefit overpayments can (and often do) result from pension calculation errors that inflate a participant’s lump sum distribution or monthly pension payment. Overpayment scenarios are common in the disability and group health...more

Easier, Less Costly Alternatives for Correcting Retirement Plan Mistakes

In two recent Revenue Procedures, the Internal Revenue Service (IRS) has modified the Employee Plans Compliance Resolution System (EPCRS), the IRS correction program for retirement plans. Revenue Procedure. 2015-27 reduces...more

ERISA: Supreme Court to Determine Whether Money is Fungible…When it Comes to Recovery of Overpayments from ERISA Beneficiaries

When it comes to recovery of overpayments from ERISA beneficiaries… money is a fungible commodity in the Eleventh Circuit, but is not a fungible commodity in the Ninth Circuit....more

US Supreme Court to Consider ERISA’s Tracing Requirements

On March 30, the U.S. Supreme Court announced it would review Bd. of Trustees of Nat. Elevator Indus. Health Ben. Plan v. Montanile, 593 F. App’x 903 (11th Cir. 2014)....more

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a...more

CMS Delays Publication of Final Rule Regarding Reporting and Returning of Medicare Overpayments

One of the most challenging compliance changes brought about by the Affordable Care Act (ACA) is the provision mandating the reporting and refunding of Medicare and Medicaid overpayments within 60 days of the date they are...more

A Delayed Christmas – Client Receives Waiver of $17,000 Social Security Overpayment

On a recent Monday morning, I opened a letter from the Social Security Administration (SSA) advising that my client’s nearly $17,000 overpayment had been fully waived. SSA had actually overpaid him for an entire year, by...more

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Breaking News: CMS Delays Final Overpayment Rule

Today, the Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline to finalize the rule implementing the Affordable Care Act provision that requires providers to timely report and return...more

CMS Needs More Time to Finalize ACA Rule on Return of Medicare Overpayments

CMS warns requirement to report/return overpayments is in effect even without regulations - The Centers for Medicare & Medicaid Services (CMS) needs more time to finalize its February 16, 2012 proposed rule on reporting...more

Revision of Overpayment Interest Rate

On January 21, 2015, a new interest rate of 10.5% for Medicare overpayments and underpayments became effective. The new rate is lower than the previous rate of 10.75% that has been in place since October 20, 2014....more

The False Claims Act and the Health Care Industry: 2014 Year in Review

On Nov. 20, 2014, the U.S. Department of Justice (“DOJ”) announced settlements and judgments for False Claims Act (“FCA”) cases totaling $5.7 billion (compared to $3.8 billion in fiscal year 2013), $2.3 billion of which was...more

Final Treasury Regulations Set Deadline for Arbitrage Rebate Overpayment Claims

Effective November 13, 2014, the filing deadline for a claim for an arbitrage rebate overpayment on tax-exempt and other tax-advantaged bonds is two years after the final arbitrage computation date for the issue from which...more

What Do I Do If I've Been Overpaid Unemployment Benefits?

A lot of times in workers’ comp cases, someone is out of work because of their work injury but are not getting workers’ comp disability compensation, either because the case has been denied or because the insurance company...more

White Collar Watch - October 2014

In This Issue: - Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars - Words can come back to haunt you: Boilerplate pleading could lead...more

Government demonstrates willingness to enforce Affordable Care Act provision that could cost providers millions of dollars

Under a little-known provision of the Patient Protection and Affordable Care Act (“ACA”), healthcare providers could face millions of dollars in liability for failing to reimburse the government for overpayments in a timely...more

Mount Sinai Seeks Dismissal of Groundbreaking False Claims Suit - October 2014

On September 22, 2014, Mount Sinai Health System (Mount Sinai) filed a motion to dismiss a groundbreaking lawsuit filed against it in a New York federal district court. The suit is the first publicly unsealed whistleblower...more

CMS Charges $13 Million Late Payment Fee on $1 Million Medicaid Overpayment

To add insult to injury, the overpayments were inadvertent—the result of electronic coding errors on about 900 Medicaid claims. On top of that, Mt. Sinai itself didn’t make the errors. They were made by two hospitals in the...more

Wall v. VistaCare, Inc.: Successor Liability for Medicare Providers

A recent decision in the Northern District of Texas provides helpful guidance for health care corporations looking to limit their potential successor liability for Medicare fraud and overpayments. On August 4, 2014, U.S....more

The ERISA Litigation Newsletter

Editor's Overview - This month's newsletter focuses on repayment of pension plan overpayments. Our issue discusses pension plan overpayments to participants, a plan administrator's duties to seek repayment, corrections...more

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