Medicare Overpayments 60 Days and 10 Years Ago

Time is expiring!

According to a new proposed regulation, healthcare providers must report self-identified Medicare over-payments within 60 days of noticing the incorrect payment or face monetary penalties.

The deadline was instituted by the Affordable Care Act policies aimed at reducing Medicare fraud.

Prior to this, providers were not given a specific time frame for returning over payments to CMS, which include:

• Medicare payments for non covered services.
• Medicare payments in excess of the allowable amount for a service.
• Duplicate payments.
• Receipt of payment when another payer was primarily responsible for payment.
• A provider reviews billing or payment records and learns that it incorrectly coded certain services, resulting in increased reimbursement.
• A provider learns that the patient died prior to the service date on a claim that has been submitted to Medicare.
• A provider learns that services were provided by an unlicensed or excluded individual on its behalf.
• A provider performs an internal audit and discovers that over payments exist.
• A provider is informed by a governmental agency of an audit that discovered a potential overpayment and then fails to make a reasonable inquiry.

The Proposed Rule contains a lookback period of ten years, meaning that a provider has to report and return an overpayment if that overpayment is identified within ten years of the date that the overpayment was received. Yikes!

Providers might be wise to review current reporting and refunding policies to confirm that practices comply with the Affordable Care Act and refining audit strategies in light of the Proposed Rule.

As this rule was announced the Administration also shared that the Health Care Fraud and Abuse Control Program had recovered $4.1 billion in Fiscal Year 2011 from anti-fraud efforts, while the Department of Justice opened 1,110 new criminal health care fraud investigations involving 2,561 potential defendants.

From RAC to Red Flags to hospice marketing investigations to home health companionship exemptions, you need a scorecard to keep track.

It's time you hire a good lawyer!

Learn more ~ or join the conversation!

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@Jeff Corwin, Getty Images