CMS finalizes rule for returning Medicare overpayments

It’s been four years since the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for how physicians should identify and return Medicare overpayments. The Feb. 11 release of the final rule, which pertains to overpayments involving Medicare Part A and Part B, was delayed by the complexity of the issue and the volume of comments received, CMS said.

The Affordable Care Act and now the CMS rule requires physicians to report and return overpayments within 60 days of identifying them. Failure to return them could lead to prosecution under the False Claims Act, including fines and financial damages.

The rule defines “identification” of an overpayment as when the physician “has or should have, through the exercise of reasonable diligence, determined that (they have) received an overpayment and quantified the amount of the overpayment.” The exact moment when the 60-day clock starts had been the subject of legal action in recent years.

The final rule also specifies that physicians are liable for overpayments going back six years. This period is shorter than the proposed 10-year period, which attracted opposition from several physician groups who said that would create a significant burden in terms of record retention.

CMS estimates the annual cost to all health care providers of complying with the new rule will range between almost $121 million and $201 million.

Posted on Feb 12, 2016 by David Twiddy