CMS 60-Day Rule: Reporting and Refunding Overpayments, Enforcement, Compliance, Self-Disclosure

Under the CMS’ rule on the mandatory reporting and returning of overpayments, known as “the 60-day rule,” Medicare and Medicaid providers, suppliers, and managed care contractors must report and return overpayments within 60 days of their identification. Retention of an identified overpayment beyond that 60-day period risks liability under the False Claims Act.

Under the rule, the clock starts when a provider has identified an overpayment. In late 2017, the U.S. Attorney’s Office for the Middle District of Florida reached a settlement for over $440,000 with First Coast Cardiovascular Institute. The settlement arose out of a whistleblower action, alleging First Coast was liable for failing to refund overpayments received from multiple government healthcare programs within 60 days of discovering it. This case demonstrates the government will enforce the rule even when a relatively small amount is involved. Further, FCA liability may arise from failure to timely refund an otherwise innocent overpayment.

Counsel to healthcare providers and suppliers must understand the rule and advise on enforcing procedures to identify, report and refund overpayments, and implement audits.

Listen as our authoritative panel of healthcare attorneys examines the CMS’ rule and offers practical steps for providers and suppliers to take in response to the 60-day rule and ensure compliance.

1. CMS’ final rule
   1. Identification of overpayments
   2. Refund processes
   3. Six-year lookback
2. Lessons from recent enforcement actions and settlements
3. Strategies for providers and supplies

The panel will review these and other high priority issues:

• When is an overpayment identified and what constitutes reasonable diligence?
• What policies and procedures should providers and suppliers implement to ensure compliance with the final rule?
• What lessons can be learned from recent enforcement actions and settlements?