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Meeting Medicare’s 60-Day Refund Rule

First few Article Sentences

As part of the Affordable Care Act, Congress enacted a statute outlining how providers should report and return Medicare and Medicaid overpayments. The 60-day refund rule, as it’s commonly known, requires Medicare and Medicaid providers and suppliers to report and return reimbursements made in error within 60 days of their identification. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for this statute in 2012, and while it addresses only Medicare overpayments—CMS proposed leaving treatment of Medicaid overpayments to be addressed at a later date—it’s worth noting that some states have implemented local policies addressing Medicaid overpayments.

While CMS’s rule has yet to be finalized, the statutory requirement introduces a significant new liability to health care providers: If you fail to return the appropriate reimbursement within 60 days, you may become liable for penalties under the False Claims Act. Failure to return the payment within the 60-day window also puts your provider organization and system at risk of exclusion from the Medicare and Medicaid programs.

Lori, Laubach

Larry Vernaglia

Moss Adams LLP

Medicare Refund Rules

April 7, 2014

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