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CMS Finalizes Medicare Overpayment Rules

Hospitals and other providers who have identified an overpayment by the Centers for Medicare & Medicaid Services (CMS) in Medicare Parts A and B now must report and return overpayments to the agency by the later of two dates:

  • within 60 days of identification
  • the due date of any corresponding cost report

The final rule that clarifies this Affordable Care Act requirement also establishes a standard for identification by stating that, “a person has identified an overpayment when the person has or should have, through the exercise of reasonable due diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.”

The final rule also establishes that hospitals and providers are subject to reporting and repayment requirements for a period of only six years from the date that an overpayment was received, instead of 10 years, as originally proposed. Providers still are subject to other legal requirements if they do not report overpayment and could be held liable under the False Claims Act and Civil Monetary Penalties Law. Additionally, failure to report overpayment might result in exclusion from federal health care programs.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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