Medicare Compliance & Reimbursement

You've always known that it's improper to hang on to money that belongs to the government -- but until now, you haven't had a strict deadline for returning it.

If the proposal is finalized, you will have to return overpayments within 60 days of identifying the incorrect payment, or on the date when a corresponding cost report is due (whichever is later).

For instance: You realize you erroneously submitted a claim for 100 units of a drug, even though the physician only administered 10 units, causing you to collect $80.00 more in reimbursement than you should have collected. Although most practices would do the right thing and return the $80.00 to their contractor immediately, CMS's proposal would ensure that you sent back the money within the newly prescribed timelines.

Penalties: If the rule is finalized, practices that don't return overpayments to Medicare within the timeline could be in violation of the False Claims Act, may be subject to civil monetary penalties, or could even be excluded from participating in federal health care programs, CMS said in a Feb. 14 statement.

Timing: Interestingly, the proposed rule was published on the same date that the Dept. of Health and Human Services announced that the government recovered nearly $4.1 billion in taxpayer dollars in 2011 -- the highest amount ever recovered over a one-year period "from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled," CMS revealed in its annual "Health Care Fraud and Abuse Control Program Report," which you can read at http://oig.hhs.gov/reports-and-publications/hcfac/index.asp.