Attorneys representing health care providers know well that our clients in the health care industry often dispute the adequacy of Medicare reimbursement. However, providers sometimes discover that they have been overpaid by Medicare. It may be a claim billed by them (or their billing agent) using a mistaken billing code, misidentification of the provider or otherwise based on an unintended mistake. Both ethics and the law require that such overpayments be repaid to the federal government. Sounds simple, however, the stakes are high if the health care provider or supplier isn’t diligent.
The Affordable Care Act (ACA), requires, in relevant part, that “if a person has received an overpayment, the person shall: report and return the overpayment …; and notify the entity to whom the overpayment was returned in writing of the reason for the overpayment.” Further, the statute requires that “an overpayment must be reported and returned by the later of the date, which is 60 days after the date on which the overpayment was identified; or the date any corresponding cost report is due, if applicable.” This is known as the “60-day rule.”
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