PBA and Associates, LLC

CMS overpayment rule

CMS overpayment rule | PBA and Associates, LLC

CMS overpayment rule

Are you concerned about how the Centers for Medicare & Medicaid Services (CMS) plan to implement the 60-day deadline for returning Medicare and Medicaid overpayments? Breath easy, there is now a proposed CMS overpayment rule in place that provides some insight. It’s all apart of the Affordable Care Act.

Section 6402(a) of the ACA created a new section 1128J of the Social Security Act, and it establishes that the failure to report and return an overpayment within 60 days of identifying its existence can give rise to liability under the False Claims Act (FCA).  The proposed rule applies only to overpayments identified by Medicare Part A and B providers and suppliers, but CMS made clear that Medicare Advantage Organizations, Medicaid Managed Care Organizations, and Prescription Drug Plans under Medicare Part D still have an obligation under various statutes to report and return overpayments.

Click here to review the fact sheets or feel free to call us with questions.