CMS gives healthcare 6 years to repay Medicare overpayments in final rule
The proposed rule mandating providers be on the hook for overpayments going back 10 years faced still opposition.
The Centers for Medicare and Medicaid Services. (Wikipedia)
The Centers for Medicare and Medicaid Services on Thursday published a final rule that requires healthcare providers to repay overpayments discovered within six years of the initial Medicare reimbursement, a much shorter lookback period than first proposed.
CMS had last February delayed the final rule due to concerns over the proposed rule mandating providers be on the hook for overpayments going back 10 years. The American Hospital Association and the Federation of American Hospitals had blasted that proposal.
Under the new final rule, providers must also return the overpayments either within 60 days of when the overpayment was found, or the due date of any cost report related to the payment. The rule applies to providers receiving payment from Medicare Parts A and B.
[Also: Continuum Health Partners, DOJ could settle case over 60-day overpayment rule]
CMS said the rule clarifies requirements for repayment and protects the Medicare Trust Fund from fraud and improper payments.
CMS also clarified what it means officially to identify an overpayment.
"This final rule states that a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment," according to the rule.
Under the Affordable Care Act, providers could be charged under the False Claim Act, hit with civil fines, or be kicked out from participating in federal reimbursement programs for failing to identify and repay overpayments.
The final rule also applies to medical suppliers that receive payments from Medicare.
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