A Review of the Final Rule Implementing the Medicare Overpayment Mandatory 60-Day Refund Statute

(282 Ratings)

Produced on: March 23, 2016

Course Format On Demand Audio

Taught by

Categories:

Course Description

Time 61 minutes
Difficulty Advanced

Health care providers are required by statute to report and return overpayments to Medicare and Medicaid. It does not matter whether the overpayment was caused by Medicare contractor error, a mistake by the provider, or action by a third party. Overpayments arise in a variety of circumstances - the claim was for services not covered, the services were not medically necessary, the payment was for a higher level of services than performed, the payment was for a Stark law prohibited violation, Medicare paid primary when another payer was properly primary, etc.  

The law requires providers to report and refund Medicare and Medicaid overpayments within 60 days after the overpayment is identified. Providers that do not properly report and refund overpayments risk False Claims Act liability, civil monetary penalties, and/or program exclusion.  

On February 12, 2016, CMS published the final rule implementing the 60-Day mandatory refund statute for purposes of Medicare Parts A and B. This final rule, which affects virtually every Medicare provider, is a mixed bag – somewhat helpful but potentially costly to providers. Moreover, although ostensibly about overpayments, this final rule is vast, also touching on compliance plans, Stark, kickbacks, appeals, reopening, limitation on liability, use of sampling, Medicare secondary payer, and more.

In this presentation, Robert Roth of Hooper, Lundy, & Bookman, a leading authority on Medicare overpayments, discusses the good, the bad, and the ugly in this final rule, including the time in which providers must complete their investigations and make refunds to Medicare. In-depth understanding of this final rule is essential for all providers. 

 

Learning Objectives:

I.     Review of the 60-day mandatory refund statute

II.    Analyze the February 12, 2016 final rule implementing the 60-day statute for purposes of Medicare Parts A and B

III.   Discuss the effect of the final rule on provider operations in-depth

IV.   Identify practical considerations when investigating overpayments and preparing disclosures

V.    Understand any updates on pending 60-day statute litigation

 

Faculty

Robert L. Roth

Hooper, Lundy & Bookman, P.C.

Robert L. Roth, a Managing Partner at Hooper, Lundy & Bookman, P.C.'s Washington, D.C. office, advises clients on matters arising under Medicare and Medicaid, focusing on payment, compliance, and licensing issues.  A former senior attorney for the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), and a former Assistant Attorney General for the State of Maryland, Mr. Roth represents a wide range of clients on federal and state regulatory and business matters.  He also represents clients in litigation at the state and federal trial and appellate court levels, as well as before state and federal administrative tribunals, including the Provider Reimbursement Review Board.  Mr. Roth is one of the select few health lawyers to have argued before the United States Supreme Court, which he did in Sebelius v. Auburn Regional Medical Center, 133 S.Ct. 817 (2013).

 

Mr. Roth represents providers and other clients throughout the country on matters such as reimbursement, overpayment refunds/disclosure, and coordination of benefits.  He also actively counsels clients on complying with the issues surrounding all aspects of the Medicare/Medicaid programs, including the Medicare Secondary Payer (MSP) statute.  Ranked by clients and peers as one of the leading health care attorneys in Washington, D.C. by Chambers USA, Bob was described as “zealous and committed” and as “stand[ing] out as having second-to-none knowledge of Medicare Secondary Payer issues.”

 

Mr. Roth began practicing privately in 1993 following an 11-year career in government, during which he served at both the state and federal levels.  At the federal level, he represented the Health Care Financing Administration (subsequently renamed CMS) as part of the HHS Office of the General Counsel.  While in that position, Mr. Roth was awarded the General Counsel’s Excellence in Legal Services Award for Outstanding Conduct in Counseling and Representing the Health Care Financing Administration in Medicare Litigation and the HHS Inspector General’s Integrity Award.  Earlier, at the state level, Mr. Roth served as an Assistant Attorney General, representing Maryland’s Department of Health and Mental Hygiene on state regulatory issues, after serving the Maryland General Assembly as Counsel to the Constitutional and Administrative Law Committee of the Maryland House of Delegates and the Commission to Revise the Annotated Code of Maryland.

Mr. Roth received his undergraduate degree from Lehigh University in history and Latin and his juris doctorate from Syracuse University College of Law.

 

Representative Matters

  • Mr. Roth’s significant litigation experience includes advising clients through the largest court settlement ever in a Medicare reimbursement case.  He successfully argued in Monmouth Medical Center/Staten Island University Hospital v. Thompson, 257 F.3d 807 (D.C. Cir. 2001), that the reopening prohibition in HCFA Ruling 97-2, which prevented the plaintiff hospitals from having their disproportionate share hospital (DSH) payment recalculated, was unlawful and that the court had mandamus jurisdiction to hear the hospitals’ challenge.  As a result of this decision, 253 lawsuits involving more than 600 hospitals were brought in the United States District Court for the District of Columbia and consolidated under the umbrella case name In Re: Medicare Reimbursement Litigation.  Mr. Roth was named one of four members of the Plaintiffs’ Coordinating Counsel, which negotiated a settlement of more than $665 million to resolve the pending lawsuits.
  • Mr. Roth’s client work also includes the successful resolution of OSF Healthcare System, Inc., d/b/a Saint Francis Medical Center v. Thompson (D.D.C.), where the client was seeking an order requiring the Secretary of HHS to delete certain MSP regulations from the Code of Federal Regulations.

 

Reviews

JH
John H.

Best CLE program ever. Jam packed with useful information. Every work spoken (and written) is helpful.

DW
David W.

Excellent presentation.

SS
Spencer S.

Great program!

GH
Gar H.

Good experienced knowledgeable presentor.

JH
Julie H.

Well organized and relevant to my current job as a compliance officer for a hospital revenue cycle management company.

HW
Heidi W.

Presenter was very knowledgeable.

JB
Julie A. B.

Valued the BNA Health Law Reporter’s 7,000-word analysis of the final rule authored by, among others, the knowledgeable speaker which is shared as supplemental material and serves as an adjunct to this interesting and informative presentation.

DW
David W.

Bob Roth's presentations are superior. Highly effective and knowledgeable. Wow! Information packed. Very important and timely topics. Recommend having him do a whole series, if he is willing!! GREAT.

JA
Joy A.

great content. learned a lot

RL
Richard L.

Excellent!

JJ
Jeanette taylor J.

Excellent presentation/presentor

SB
Stephanie B.

Speaker spoke really fast! Had a LOT of information to impart and did it very well.

SO
Stanley O.

Excellent presentation. Well prepared and presented with detail and practical insight.

SS
Steve S.

I learned a lot about this subject

JB
John B.

Good speaker

AS
anne S.

Wish it had been a 1.5 hr course. There was more than enough material to justify it!

MH
Michael H.

Very nice presentation

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