This course is no longer available for credit on our site. Explore our online catalog to view more courses
On Demand
Unlimited

Medicare and Medicaid Overpayments: Meeting the Refund and Reporting Obligations and Avoiding Program Exclusions and False Claims Act Liability

1h 31m

Created on June 17, 2015

Advanced

Overview

Health care providers are required by law to report and return overpayments to Medicare and Medicaid. It does not matter whether the overpayment was caused by Medicare contractor error or a mistake by the provider.  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, etc.

 

The law requires Medicare and Medicaid overpayments within certain time parameters. Providers that do not properly report and refund overpayments risk violating the False Claims Act, civil monetary penalties, and/or program exclusion.  There are special rules that apply when the patient is in a Medicare or Medicaid managed care plan, or a Medicare Part D plan.

 

In this presentation, Robert Roth of Hooper, Lundy, & Bookman discusses how providers must determine the amount of overpayment, the reporting and refund obligations, as well as the government's recovery rights when considering whether, when, and to whom to make repayments to Medicare and Medicaid.

 

Learning Objectives:

I.      Identify when repayment/disclosure is not voluntary – the origins and scope of the 60-day report and repayment statute

II.     Analyze the Final Rule on implementation of 60-day statute for Medicare Parts C and D

III.    Summarize the updates on Proposed Rule for Medicare Parts A and B

IV.    Describe the Proposed Rule for Medicaid Managed Care

V.     Discuss which agency an overpayment should be reported to

VI.    Discover practical considerations when investigating overpayments and preparing disclosures

VII.   Describe the updates on pending 60-day statute litigation

 

Gain access to this course, plus unlimited access to 1,800+ courses, with an Unlimited Subscription.

Explore Lawline Subscriptions