Description
CMS recently issued a final rule, effective Jan. 1, 2025, updating and clarifying requirements for reporting and returning Medicare and Medicaid overpayments to address concerns raised since the regulations implementing the 60-day rule were published in 2016.
One of the key revisions amends the standard for determining when an overpayment has been identified, as derived from the False Claim Act, to initiate the obligation to report and return funds. Formerly, an overpayment was identified when the provider, through the exercise of reasonable diligence, determined it had received an overpayment and quantified the amount. Under the new rule, an overpayment is identified when an entity or individual "knowingly" receives or retains an overpayment by having actual knowledge of the overpayment or acting in deliberate ignorance or reckless disregard of the overpayment. Under the new rule, the 60-day clock to refund the overpayment starts as soon as an overpayment has been identified, regardless of whether it has been quantified.
Another key update allows for suspension of the 60-day return period for 180 days for the purpose of conducting a timely, good faith investigation to determine the existence of related overpayments that may arise from the same or similar cause as the initially identified overpayment.
Counsel should understand the new rule's requirements to guide clients through its application to processes and procedures and to mitigate risk of noncompliance.
Listen as our expert panel provides a comprehensive overview of the CMS updates to the 60-day rule governing the reporting and return of Medicare and Medicaid overpayments. The panel will discuss the impact on healthcare providers and suppliers and offer best practices for compliance.
Presented By
Mr. Duffy advises hospitals, physician groups, community providers, and other healthcare entities on general corporate matters and health law issues. He also counsels clients on what measures are needed to safeguard data and patient information. Mr. Duffy provides legal counsel to healthcare clients on various regulatory matters, such as Medicare and Medicaid program compliance, federal fraud and abuse laws, and the EMTALA. He also assists with the full spectrum of state health law matters, including those related to licensure and staffing. Conor represents clients in state and federal administrative appeals and provides counsel related to internal investigations. He is a frequent speaker and writer on recent developments in fraud and abuse enforcement and False Claims Act jurisprudence. In addition to the Health Law Group, Mr. Duffy is a member of the Data Privacy + Cybersecurity team, and assists healthcare providers with compliance with the HIPAA, among other matters. He is a Vice-Chair of the ABA Health Law Section’s Web & Tech Committee.
Mr. Hopkins helps to protect healthcare providers and healthcare companies against the many potential pitfalls in the industry, serving as both an advocate and educator for his clients in administrative law, regulatory defense, compliance, and litigation. He advises the full spectrum of healthcare clients from individual providers, healthcare companies to institutional healthcare clients. Mr. Hopkins focuses on state and federal licensure, regulatory compliance, and enforcement matters, with an emphasis on proactive legal services aimed at maintaining compliance and minimizing potential legal exposure. Mr. Hopkins handles all aspects of healthcare professional licensure and practice; long-term care licensure, regulation, and enforcement; medical staff issues, credentialing, fraud, and abuse; and compliance with rules of state and federal regulatory agencies. He has litigated on behalf of his clients in both state and federal administrative courts, as well as the District Courts of Texas. Additionally, Mr. Hopkins is a recognized thought leader and prolific speaker on healthcare regulatory, enforcement, and compliance matters at the local, state, and national levels.
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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Date + Time
- event
Thursday, May 22, 2025
- schedule
1:00 p.m. ET./10:00 a.m. PT
- Introduction: history of the 60-day rule
- CMS final rule
- New standard for "identified" overpayment
- 180-day period to investigate overpayments
- Impact on healthcare providers and suppliers
- Best practices for compliance
- Practitioner takeaways
The panel will review these and other important considerations:
- How does the new rule change the standard for when an overpayment is "identified?"
- For what purpose does the new rule provide for a 180-day investigation period? How does this impact the 60-day return period?
- What are best practices for guiding healthcare clients through policy and procedural updates?
