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New Overpayments Rule Effective TODAY; Policies Must Be Updated

By March 14, 2016August 11th, 2017Compliance & Ethics

CMS issued its final rule regarding provider and supplier obligations regarding Medicare Part A & B overpayments on February 12, 2016. This new rule is effective TODAY, March 14, 2016.

If you have not already done so, and you are a provider that bills to Medicare Part A or B, you should ensure you and your team are well-versed in the new rule’s requirements. You should also ensure that your organization has in place an updated overpayments policy that instructs your employees on how to comply with the new rule’s requirements for investigating, reporting and returning Medicare overpayments.

For a detailed summary of the new rule, please see the discussion on our BLOG.

Key elements include:

  • Providers and suppliers are required to use reasonable diligence to investigate credible information regarding overpayments through both proactive compliance efforts and reactive investigations.
  • Providers and suppliers only have up to 6 months to investigate and quantify an overpayment (i.e., to identify it) and up to 60 days to report and return the overpayment.
  • Providers and suppliers are required to report and return all overpayments within a 6-year lookback period.
  • Failure to report and return an overpayment could subject the provider or supplier to False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from the federal health care programs.

If you have any questions regarding potential overpayments and steps you must take to comply with the new rule, please contact either Carol Rolf or Aric Martin.

ROLF also has a template overpayments policy available for purchase upon your request. If you would like to purchase ROLF’s overpayment policy, please contact Aric Martin.

Please note that this alert is intended to be informational only, and is not intended to be nor should it be relied upon as legal advice. Rolf Goffman Martin Lang LLP will not be responsible for any actions taken or arrangements structured based upon this alert. The receipt of this alert by an organization that is not a current client of Rolf Goffman Martin Lang LLP does not create an attorney-client relationship between the recipient and the law firm.

©2016. Rolf Goffman Martin Lang LLP. All Rights Reserved.