Medicare Overpayment Rules Are a Mixed Bag for Providers

Healthcare attorney Susan Banks published an article in Law360 analyzing updates from the Centers for Medicare & Medicaid Services (CMS) to regulations interpreting the federal 60-day overpayment refund requirement. Under the federal overpayment statute, anyone who receives or retains Medicare or Medicaid funds to which they are not entitled must report and return the overpayment to the appropriate government official or contractor within 60 days of identifying it, and violators may be held liable under the False Claims Act (FCA). Ms. Banks characterizes CMS' updates to the statute as a "mixed bag," with the abandonment of the reasonable diligence standard on one side and the codification of a challenging 180-day time frame for follow-up audits on the other. In this article, she dives deeper into the 180-day investigatory time frame, describing a hypothetical scenario provided by CMS and outlining potential concerns for providers. She also provides practical takeaways concerning compliance and minimizing FCA liability.

Ms. Banks previously authored a Holland & Knight Healthcare Blog on this topic.

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