The Centers for Medicare & Medicaid Services (CMS) proposed a rule late last year to harmonize the standard it would apply for providers to identify and refund overpayments with the “knowledge” standard under the False Claims Act (FCA) and the Civil Monetary Penalties Law. Though this proposal purportedly ensures that a lack of “reasonable diligence” cannot create civil liability, it would create significant confusion as to how CMS expects providers and Medicare Advantage organizations (MAOs) to “identify” and quantify potential overpayments before triggering the 60-day period to refund them. The proposed rule, if adopted, would likely become part of the framework for the Department of Justice and Department of Health & Human Services’ Office of Inspector General when evaluating potential liability for the alleged failure to return overpayments.
The statutory changes regarding overpayments, which were added in 2010 as part of the Affordable Care Act, require health care providers, suppliers, Medicaid managed care organizations, MAOs, and prescription drug plan sponsors to report and return overpayments from Medicare or Medicaid within 60 days of identification or by the date any corresponding cost report is due – whichever is later. Retention of the overpayment after the deadline passes results in an “obligation” under the FCA, which creates FCA liability under a so-called reverse false claim theory for knowingly concealing or knowingly and improperly avoiding an...
Tehran – Saba: The Iranian Foreign Ministry condemned the subversive actions taken by the rulers of Abu Dhabi against the Islamic Republic of Iran. Last night, Tasnim News Agency reported that the...