CMS Medicare Overpayment Reporting Requirements
The Centers for Medicare & Medicaid Services on Feb. 12, clarifies reporting and repayment obligations for providers and suppliers who receive a Medicare overpayment. ?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? the final rule explains.
Timing is everything, when reporting.
Section 1128J(d)(2) of the Social Security Act ? as amended by Section 6402(a) of the Affordable Care Act ? requires a medicare overpayment to be reported and returned within 60 days after the date on which the overpayment was identified; or the date any corresponding cost report is due, if applicable is effective March 14, 2016. Providers and suppliers must also notify the secretary of the U.S. Department of Health & Human Services, the state, an intermediary, a carrier, or a contractor of the reason for the overpayment, in writing.
The overpayments must be reported and returned only if a person identifies the overpayment within 6 years of the date the overpayment was received.
It should be noted that providers and suppliers could face potential False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from federal healthcare programs for failure to report and return an medicare overpayment.
The Medicare program (title XVIII of the Act) is the primary payer of health care for approximately 50 million enrolled beneficiaries. Providers and suppliers furnishing Medicare items and services must comply with the Medicare requirements set forth in the Act and in CMS regulations. The requirements are meant to ensure compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against fraud and improper payments. As part of our efforts to reduce fraud, waste, and abuse in the Medicare program, we twice proposed, but did not finalize, rules that would have amended our regulations to codify the longstanding responsibility of persons to report and return Medicare overpayments. (See the March 25, 1998 (63 FR 14506) and January 25, 2002 (67 FR 3662) proposed rules.)