# Required to Refund?



## Lassal423 (Dec 13, 2013)

Does anyone know if there is a regulation that you MUST refund Medicare, if you identify an overpayment?  Does it vary by state?  Is there a timeframe in which the refund must be sent?

Thanks!
Lora


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## MarcusM (Dec 13, 2013)

http://www.cms.gov/Outreach-and-Edu...ducts/downloads/OverpaymentBrochure508-09.pdf

Here's some good information.  You can get into trouble for not refunding once you identify an overpayment.  I advise making sure it is an actual overpayment and not an adjustment error, and document your audit procedures.


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## Peter Davidyock (Dec 13, 2013)

60 days once it's been identified.


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## searchthweb (Dec 18, 2013)

Lassal423 said:


> Does anyone know if there is a regulation that you MUST refund Medicare, if you identify an overpayment?  Does it vary by state?  Is there a timeframe in which the refund must be sent?
> 
> Thanks!
> Lora


Hello

I would be careful about this.  The reason being that if your doctor's office refunds the overpayment (without Medicare asking for it), and Medicare has not yet audited their books yet (that would show this overpayment), then you may be refunding to Medicare - when Medicare is not even aware an overpayment exists.  So, some time later, you may receive a letter from Medicare asking for that refund - when you have already refunded that money.  So, I would say, "You don't have to refund Medicare for an overpayment - if they haven't asked for it.  Wait until Medicare has  recognized it in their books."  Otherwise, you'll be spinning your refund wheels for nothing.  Others may see this as a bit "unethical," but I think refunding an overpayment (when it is not yet asked for from the Payor), is causing more of a problem. I also don't think there is any kind of written rule (regulation) for overpayments.  I have refunded an overpayment to Medicare before, and it only confused them and caused a huge problem for the doctor I was working for.


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## lorrpb (Dec 18, 2013)

If you receive an overpayment from Medicare, it is government money that you are not entitled to. You are obligated to notify your MAC of the overpayment within a timely manner, which is generally considered to be less than 60 days. Your MAC will review it and tell you how they wish to recoup the funds, which may be through a deduction on a future payment. Do not just randomly send a check to Medicare because they may be unable to track it, as stated above. I would not mess around this.

https://www.americanbar.org/newsletter/publications/aba_health_esource_home/geroulo.html#_ftn2


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## MnTwins29 (Dec 18, 2013)

*ACA states that provider must return overpayment*

Oceanlivin is correct.   Under section 6402(d)(1) of the ACA, when a provider identifies an overpayment, then that provider has 60 days to return that overpayment to Medicare.   One CANNOT wait until Medicare audits or otherwise requests the money back.   If that scenario happens, submit proof that the overpayment was refunded.


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## Peter Davidyock (Dec 25, 2013)

searchthweb said:


> Hello
> 
> I would be careful about this.  The reason being that if your doctor's office refunds the overpayment (without Medicare asking for it), and Medicare has not yet audited their books yet (that would show this overpayment), then you may be refunding to Medicare - when Medicare is not even aware an overpayment exists.  So, some time later, you may receive a letter from Medicare asking for that refund - when you have already refunded that money.  *So, I would say, "You don't have to refund Medicare for an overpayment - if they haven't asked for it. * Wait until Medicare has  recognized it in their books."  Otherwise, you'll be spinning your refund wheels for nothing.  Others may see this as a bit "unethical," but I think refunding an overpayment (when it is not yet asked for from the Payor), is causing more of a problem. I also don't think there is any kind of written rule (regulation) for overpayments.  I have refunded an overpayment to Medicare before, and it only confused them and caused a huge problem for the doctor I was working for.




"A bit unethical" ???

I cannot remember reading anywhere in the bylaws and ethics of this organization a statement that says it's okay or advised or proper to hide over payments from the federal government until they come looking for them. To espouse such a stance and make such a statement in a public forum calls your integrity and honesty into question for me. It also worries me that you may be a credentialed member. Are you a credentialed member?

I find you post to be highly unethical but hey that's just me. Hopefully someone higher in the organization will read this thread.


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## MarcusM (Dec 27, 2013)

"Fraud:
 The intentional misrepresentation or deception resulting in payment(s) for services not rendered or payment above that normally paid. See Medicaid fraud, Medicare fraud Patient care Dishonest practice; breach of confidence. See AIDS fraud, Health fraud. Cf Misrepresentation.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

http://www.healthlawyers.org/Events/Programs/Materials/Documents/Fraud10/roth_enclosures_b.pdf

"Overpayment refunds must be made within sixty days after they arise...."


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## ReneeGillam CPMA CMOM CMC (Dec 31, 2013)

You definitely want to refund the overpayment.


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## CBlanton (Jan 31, 2014)

I think this needs to be put on a Medicare Credit Balance Report.


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## Melissa Harris CPC (Jan 31, 2014)

It is a good rule to inform Medicare of the overpayment and let them reprocess the claim and request the refund.   I have found in the past that sometimes when refunding Medicare in a COB situation, their system is updated in the interim and the money is not due to be refundd to Medicare.  

Melissa


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## CBlanton (Jan 31, 2014)

The amount Needs to go on a CMS-838 Credit balance report and repaid or adjusted. Medicare will suspend payments if you don't.
These are suppose to be sent in after each quarter of the year.


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## ABonnell CPC (Feb 10, 2014)

You'll want to issue a refund, however, if you do so before its identified by the payer, you'll want to take the extra step of calling to alert them to the over payment, and not just send it.  As some have said, simply sending in the refund when its not expected can create a lot problems.  By calling, its alerts them to the over payment so they will be expecting the refund.  Its extra work at first, but will save A LOT of work in the end.


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