Medicare Overpayment

On February 12, 2016, the Centers for Medicare and Medicaid Services issued a Final Rule that specifies the time frame for reporting and returning overpayments.  A new Section 1128J(d)(1) of the Affordable Care Act requires a person who has received an overpayment under parts A or B of the Medicare program to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier or contractor to whom the overpayment was returned in writing of the reason for the overpayment.

Overpayment is defined as:

any funds that a person has received or retained under title XVIII of the Act to which the person, after applicable reconciliation, is not entitled under such title.”

The Rule states that providers receiving funds under the programs must return overpayments by the later of:

  • 60 days after the date on which the overpayment was identified; or
  • the date any corresponding cost report is due, if applicable.

The Final Rule is effective March 14, 2016. Please refer to the April issue of the American Practice Advisor for more information.