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CMS Delays Final Rule on Overpayment Reporting

The health care industry will have to wait a bit longer for the much-anticipated CMS final rule on overpayment reporting. On Feb. 17, 2015, CMS announced that it will delay publication of the Final Rule to February 16, 2016, citing “significant policy and operational issues” raised by commenters to the Proposed Rule that require further collaboration with the Department of Justice and Department of Health and Human Services’ Office of the Inspector General.

The Proposed Rule, originally published on February 16, 2012, seeks to implement section 6402(a) of the Affordable Care Act entitled “Reporting and Returning of Overpayments.” Section 6402(a) requires overpayment recipients to report and return any overpayments, including a written explanation of the reason for the overpayment, by the later of (a) 60 days after the date on which the overpayment was identified or (b) the date any corresponding cost report is due. The Proposed Rule addresses several key implementation issues, including the definition of “identification,” clarification of reporting and returning deadlines, proposed look-back periods, and the interplay between the reporting rules and CMS and OIG self-disclosure protocols.

The sheer volume of comments received in response to the Proposed Rule reflects the industry’s strong need for clarity concerning its overpayment obligations. Nonetheless, in its February 15 continuation notice, CMS reminds stakeholders that delay of the final regulation does not relieve them of their statutory obligation to return and report overpayments and that failure to do so exposes them to potential liability under the False Claims Act and Civil Monetary Penalties law as well as exclusion from federal health care programs.

© 2023 BARNES & THORNBURG LLPNational Law Review, Volume V, Number 56
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About this Author

Heather Delgado Healthcare Attorney
Partner

Healthcare providers depend upon Heather Delgado for her commitment to responsiveness and practical legal advice. Heather focuses on finding the right solution for her clients. She is valued for her ability to overcome the obstacles her clients face and for her skill in applying complex laws and regulations to their business practices.

Heather’s experience includes the representation of healthcare providers, including hospitals, health systems, specialty hospitals, ambulatory surgery centers, multi- and single-specialty medical practices, and a wide variety of healthcare...

312-338-5905
Mark E. Rust Barnes Thornburg Law firm Chicago Corporate Finance and Healthcare Law Attorney
Partner

Mark Rust is Managing Partner of the Chicago office of Barnes & Thornburg, LLP, and Chair of the firm’s national Healthcare Department. Mr. Rust concentrates his practice in transactional, regulatory and medical-legal issues affecting healthcare entities and provider organizations. For nearly 30 years he has written about or practiced in healthcare law, writing in a wide variety of publications from theJournal of the American Bar Association to USA Today. He is listed as a notable healthcare lawyer in Chambers USA, Top Healthcare Lawyers of Illinois,Superlawyers...

312-214-8309
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