Recent Developments Regarding Healthcare Voluntary Refunds Under the Affordable Care Act

Almost all healthcare providers face at some point having to disclose and refund potential overpayments to Medicare, Medicaid and other federal healthcare programs. Under the Affordable Care Act (“ACA”), a written disclosure and refund must occur within 60 days after an overpayment has been “identified.” Without interpretive regulations, providers are struggling nationwide with trying to understand and comply with the ACA’s requirements and the potential liabilities under the False Claims Act (“FCA”) for failure to comply. A recent federal decision in New York in Kane v. Healthfirst, Inc. et al., as well as the pending appeal before the US Supreme Court in the Universal Health Services case, have only added to the uncertainties. Join Sheppard Mullin partner Steven Chananie for an in-depth discussion of the law and the impact of the recent cases, and an exploration of practical strategies on how to navigate the ACA’s requirements.

Learning Objectives:

I.     Gain an understanding of the requirements and legal standards of the ACA and the FCA as to disclosing overpayments; the open issues under these laws; and the impact of the decision in Kane and the appeal in Universal Health Services

II.    Learn practical strategies on how and when to conduct internal reviews of potential overpayments so as to minimize potential legal liability under the FCA (e.g., when a review must be done; how quickly it must be completed; how far back to go; how to select cases for review; how to quantify the overpayment, etc.)

III.   Understand the relevant considerations regarding: (i) when and how to interact with the government, given the time limitations set forth in the ACA and the unsettled state of the law; (ii) which state or federal entities to contact; and (iii) what the potential liabilities and penalties might be under the FCA, even when a timely disclosure is made