CMS issues final rule for reporting, repaying Medicare overpayments

The Centers for Medicare & Medicaid Services today issued a final rule implementing Section 6402(a) of the Affordable Care Act, which creates a reporting and repayment obligation for providers and suppliers who receive a Medicare overpayment. The final rule requires providers and suppliers to report and return any overpayments they identify within six years of receipt, down from a 10-year look back period in the proposed rule. “We welcome the federal government’s reversal of its proposed 10-year look back period,” said AHA Executive Vice President Tom Nickels. “It would have created an extraordinary burden on hospitals, and was premised on a flawed application of the False Claims Act to payment policy.” Once identified, overpayments must be reported and returned within 60 days or by the due date for any corresponding cost report. According to the final rule, “a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.” AHA staff continue to evaluate the details of the final rule and will get additional analysis to members soon. The association commented on the proposed rule in 2012.