Since the implementation of the 60-day Rule requiring the return of overpayments within 60 days of identification, Part A and B providers have been deemed to have identified an overpayment when, upon acting in reasonable diligence, an overpayment is known and quantified. On December 27, 2022, however, the Centers for Medicare and Medicaid Services (CMS) published a Notice of Proposed Rulemaking requesting comment on its proposed revision of 42 CFR §401.305(a)(2) and §§ 422.326(c) and 423.360(c) to establish liability for an overpayment based on the knowledge definition of the False Claims Act statute, 42 U.S.C. 1320a-7k(d)(3).
From 2018 to 2022, CMS was party to litigation challenging the “reasonable diligence” standard for searching and identifying overpayments on the ground that the “reasonable diligence” standard would make a provider liable for mere negligence. The basis for the challenge is that CMS overstepped its rulemaking authority under the Administrative Procedure Act when implementing the regulation for Medicare Parts C and D. The appropriate test established by the Court is the ACA’s definition of knowledge under the False Claims Act: “The District Court noted that ‘(t)he False Claims Act—which the ACA refers to for enforcement, see 42 U.S.C. 1320a-7k(d)(3)—imposes liability for erroneous (‘false’) claims for payment submitted to the government that are submitted “knowingly’ … a term of art defined in the FCA to include false information about which a person...
Patricia White, 70, of Old Greenwich, received a nine-month prison sentence for submitting false claims for unclaimed properties to around 30 state treasuries. HARRISBURG, Pa. — Months after her br...