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 case pursued by the government that seeks to enforce the so- called “60- Day Rule” for the return of overpayments of federal health care program funds set forth by the Patient Protection and Affordable Care Act (PPACA).
The 60- Day Rule requires a provider to return an overpayment received from a federal health care program within 60 days after the date on which the overpayment is identified and to document the reason for the overpayment. Any overpayment not returned to the government within the 60- day time frame constitutes an “obligation to pay” under the federal False Claims Act (FCA) and is therefore subject to treble damages and civil penalties under the FCA. The PPACA does not define the point at which an overpayment is “identified,” which has led to uncertainty among providers regarding how to comply with the 60- Day Rule.
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