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New Settlement Program for Medicare Overpayments

Medicare providers who have overpayments with pending requests for Administrative Law Judge (ALJ) hearings filed on or before March 31, 2019, may now take advantage of the renewed Settlement Conference Facilitation (SCF) program. This program allows the providers to meet with CMS representatives to discuss the possibility of a mutually agreeable resolution of the issues now rather than having to wait for months or even years longer to have their cases heard by a judge. Moreover, this is an opportunity for providers who have already re-paid most or all of their overpayment to begin to recover some of those monies. This is the first renewal of the program since a similar one was opened to parties with hearing requests pending prior to November 2017.

The process works much like a civil mediation, where an employee of the Office of Medicare Hearings and Representatives meets with CMS and the provider’s representatives and attempts to get them to agree based on the strength and weaknesses of their positions. There is no obligation for the parties to agree or guarantee that the case will be resolved. As with earlier versions of the program, the intent in large part is to reduce the huge backlog of appeals pending at the ALJ level. Providers with significant overpayments would still be well-advised to engage legal counsel in connection with the process to maximize the potential for a favorable outcome.

© Polsinelli PC, Polsinelli LLP in CaliforniaNational Law Review, Volume IX, Number 213


About this Author

Michael P Gennett Attorney Polsinelli Miami, Health Care Licensing, Medicare and Medicaid, Compliance and Regulatory Issues

With his wide-range of experience in the health care sector, Michael P. Gennett focuses his practice on the health care licensing, Medicare and Medicaid compliance and regulatory issues. He represents health care practitioners and providers, medical practices, medical equipment companies, pharmacies and large medical centers. Michael has successfully defended health care providers in Medicare and Medicaid appeals, prepayment reviews and other reimbursement issues, in addition, he has handled False Claims Act whistleblower cases and data breaches. He has also assisted health care clients in...