60 Days to Pay – Has Medicare Reached the Point of No Return?

Abstract

In February the Centers for Medicare & Medicaid Services (“CMS”) clarified an oft quoted existing rule: Providers must return overpayments to Medicare within 60 days “after the date on which the overpayment was identified,” or in the alternative, “the date any corresponding cost report is due, if applicable.” For providers of any size, failure to report and return Medicare overpayments pursuant to these temporal requirements may result in potential liability under the Federal False Claims Act, resulting in substantial monetary penalties and the risk of being denied future claims for reimbursement.The systemic problems facing the Medicare system today should not be underestimated, especially when escalating health care expenses threaten the system’s future sustainability. Institutional survival, however, is also an undeniably critical component in the delivery of health care, especially if future Medicare beneficiaries intend to access the health care services to which they are entitled under any Federal health program. Fully understanding the alternative deviates slightly from tenets of medicine and science, and perhaps is better phrased by philosopher George Berkeley: “But, say you, surely there is nothing easier than for me to imagine trees, for instance, in a park [...] and nobody by to perceive them. [...] The objects of sense exist only when they are perceived; the trees therefore are in the garden [...] no longer than while there is somebody by to perceive them.”