Practice Management Alert
The Lowdown on the 60-Day Overpayment Rule
Just last year, CMS issued a rule that set a 60-day limit on returning overpayments to federal health programs. Another billing compliance rule – what’s the big deal?
The big deal is that this simple-seeming rule actually represents a sea change in compliance, and a practice that fails to comply with it could be facing crippling penalties. “It was the first time that a specific deadline was imposed on returning excess payments by Medicare,” attorney Wayne Miller of the Compliance Law Group told Practice Management Alert. “Before this point, there was no specific timeframe in which overpayments had to be returned.”
System fix: Every practice handles overpayments from time to time, but the 60-day rule is designed to help practices identify systemic overpayment problems. Federal officials expect providers to sniff out coding or billing issues, and to move swiftly to address those issues. Any overpayments you discover should then be refunded within the 60-day window, and the underlying problem fixed to avoid future overpayments.
Why should you move quickly to address a pattern of overpayment when you find it? Because if the feds discover that you knew about the overpayments and failed to promptly repay them, warns attorney Alan Reider of Arnold & Porter, you could be looking down the barrel of the False Claims Act or the Civil Monetary Penalties Law. They could even move to bring down the ultimate hammer: exclusion from all federal healthcare programs.
Qui tam risk: And if you think you’ll skate by undetected, remember that any member of your staff could become a qui tam relator and turn you in, with the promise of a hefty cash payout to the whistleblower.
It’s no fun to identify an overpayment, especially if it turns out to be part of a larger issue that requires work to fix. But once you do identify the issue, it’s in your interest to correct it, both to avoid penalties and because it’s the right thing to do. After all, observes Reider, “You’ve been overpaid. You’ve got to pay it back.”
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