News & Alerts

Centers for Medicare and Medicaid Services Finalizes Rule on Reporting Medicare Overpayments—Six Year Lookback Period Imposed

February 11, 2016

The Centers for Medicare and Medicaid Services (“CMS”) released its final rule this morning requiring Medicare Parts A and B providers and suppliers to report and return overpayments by 60 days after the date an overpayment was identified. 

The original version of the rule, which was first proposed in 2012, raised concern in the healthcare field when it entertained a lookback period going back as far as 10 years.  The American Hospital Association and the Federation of American Hospitals criticized the unreasonableness of the timeframe contained in the proposed rule. 

Under the final rule, overpayments must be reported and returned only if the provider or supplier identifies the overpayment within six years of the date the overpayment was received.  The final rule also includes provisions designed to clarify the meaning of overpayment “identification” and the methods available for reporting and returning identified overpayments to CMS. 

According to the final rule, an overpayment must be reported and returned by the later of:

  1. The date which is 60 days after the date on which the overpayment was identified; or
  2. The date any corresponding cost report is due, if applicable.  

An overpayment is identified if the provider or supplier has actual knowledge of the existence of the overpayment or acts in reckless disregard or deliberate ignorance of the overpayment.  The final rule states that providers and suppliers must use an applicable claims adjustment, credit balance, self‑reported refund, or another appropriate process to satisfy the obligation to report and return overpayments.  

Providers and suppliers with questions regarding overpayments should consult with their advisors.

Jane Duke is a former U.S. Attorney and current Member practicing in health care law at Mitchell Williams. Jane can be reached at (501) 688.8842 or jduke@mwlaw.com.