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CMS Finalizes 60 Day Overpayment Rule

The final rule relaxes the requirements on “identification” and look-back period.

The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of Medicare Part A and Part B overpayments (60 Day Rule).

Finalized nearly six years after the enactment of the Affordable Care Act (ACA), the final rule clarifies that an overpayment is “identified” when a provider or supplier “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.” CMS notes that this standard should provide needed clarity and consistency for the application of the 60 Day Rule. Providing some expected and welcome relief, the final 60 Day Rule also provides for a look-back period of 6 years instead of the 10 years CMS had initially put forward in its 2012 proposed rulemaking. 

The 60 Day Rule will go into effect 30 days after its publication in the Federal Register, which is expected on February 12, 2016. Medicare providers and suppliers should remember that the obligation to report and refund identified Medicare overpayments has been required by the statute since the ACA’s enactment in 2010.

Copyright © 2022 by Morgan, Lewis & Bockius LLP. All Rights Reserved.National Law Review, Volume VI, Number 42
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About this Author

Howard Young, Morgan Lewis, Healthcare lawyer
Partner

A nationally recognized leader in healthcare fraud and abuse and regulatory issues, Howard J. Young leads the Morgan Lewis healthcare practice and co-leads the healthcare industry initiative where he advises a range of healthcare clients on government investigations, regulatory, and transactional matters. Healthcare organizations turn to Howard to address their most critical legal, compliance and strategic business issues and to assist with internal and government investigations and self-disclosures. Howard regularly advises investors, including private equity firms, on...

202-739-5461
Albert Shay, Morgan Lewis, Healthcare attorney
Partner

Albert W. Shay focuses his practice on counseling healthcare companies of all types on regulatory, fraud and abuse, Stark law, Medicare reimbursement, and transactional matters. Al devotes a substantial portion of his practice to corporate compliance issues, including internal and government investigations, and has experience representing clients before regulatory agencies such as the Centers for Medicare and Medicaid Services (CMS), the US Department of Health and Human Services’ Office of Inspector General, and the Provider Reimbursement Review Board.

202-739-5291
Andrew Ruskin, Morgan Lewis, Healthcare and life sciences attorney
Partner

Andrew Ruskin counsels hospitals, pharmaceutical and medical device companies, and Medicare Advantage plans, among others, on a range of Medicare and Medicaid regulatory, litigation, and transactional matters. Andy advises on strategic issues surrounding coverage, reimbursement, and compliance, as well as drug pricing and price reporting. He defends clients in investigations by the US Attorney’s Office and the Department of Health and Human Services Office of Inspector General, and he appears before several regulatory tribunals, such as the Provider Reimbursement Review...

202-739-5960
Jacob Harper, healthcare attorney, Morgan Lewis
Associate

Jacob Harper advises stakeholders across the healthcare industry, including hospitals, health systems, large physician group practices, practice management companies, hospices, chain pharmacies, manufacturers, and private equity clients, on an array of healthcare regulatory, transactional, and litigation matters. His practice focuses on compliance, fraud and abuse, and reimbursement matters, self-disclosures to and negotiations with OIG and CMS, internal investigations, provider mergers and acquisitions, and appeals before the PRRB, OMHA, and the Medicare Appeals Council...

202-739-5260
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