New Requirement for Self-Disclosing CMS Overpayments

Abstract

Among the many items in the recently enacted health care reform legislation aimed at improving the integrity of the Medicare and Medicaid programs is a key provision establishing, for the first time, a time limit for health care providers to disclose and return overpayments. Specifically, section 6402 of the Patient Protection and Affordable Care Act requires that any Medicare or Medicaid funds received or retained to which a health care provider is not entitled must be reported and refunded within 60 days from the date the overpayment was “identified” or by the date any corresponding cost report is due (if applicable) to the appropriate agency (eg, Medicare or Medicaid contractor, state oversight agency). Moreover, the report must include a written explanation of the reason the overpayment occurred. This provision went into effect immediately upon enactment in March.