CMS Proposes Rule on Reporting and Returning Overpayments
CMS has proposed a rule regarding reporting and returning overpayments through the Medicare program. This proposed rule is meant to reduce fraud, waste, and abuse. Under the proposed rule, within 60 days of discovering of the overpayment, any health care provider or supplier who is overpaid must report and return the payment and provide written notification of the reason for the overpayment.
CMS proposes implementing the overpayment report and return process through the existing voluntary refund process. The voluntary refund process would be renamed the “self-reported overpayment refund process.” Providers would, therefore, report overpayments by using a form that Medicare contractors make available on their website. The reports currently include, and would continue to include under CMS’s proposal, identification of:
- how the error was discovered;
- a corrective action plan implemented to ensure that the error does not occur again;
- the reason for the refund;
- whether the provider or supplier has a corporate integrity agreement (CIA) with the OIG or is under the OIG Self-Disclosure Protocol;
- identification of the time frame and total refund for the period during which the problem existed;
- information related to claim numbers; and,
- identification of any statistical sample used to determine the overpayment amount.
Health care providers must keep in mind that actual knowledge of an overpayment is not necessary to trigger the mandated report and return. Under the proposed Rule, CMS deems a person to have identified an overpayment if they have actual knowledge of the overpayment or if the person acts in reckless disregard or deliberate ignorance of the overpayment. Therefore, the proposed Rule mandates that providers and suppliers take steps to determine whether an overpayment has occurred through actions such as self-audits, compliance checks, or other additional research.
Health care providers and suppliers should monitor this proposed Rule and the ultimate adoption of a final Rule. Failing to report and return overpayments in accord with CMS’s regulations can result in civil monetary penalties, potential liability under the False Claims Act, and potentially exclusion from the Medicare program. CMS is accepting comments on the proposed Rule until 5:00 p.m. on April 16, 2012