CMS Issues Proposed Rule for Reporting and Returning of Overpayments

February 23, 2012

CMS has issued a proposed rule implementing the requirements for reporting and returning overpayments set forth in the Affordable Care Act.  “This proposed rule would require providers and suppliers receiving funds under the Medicare program to report and return overpayments by the later of the date which is 60 days after the date on which the overpayment was identified; or any corresponding cost report is due, if applicable.”

The Proposed Rule would result in heightened reporting burdens and uncertainty for providers and suppliers. Key features include the following:

  • Adoption of an existing voluntary refund process as the sole methodology for reporting overpayments, absent self-disclosure under the OIG Self-Disclosure Protocol (OIG SDP).
  • An “actual knowledge, reckless disregard or deliberate ignorance” standard for determining when an overpayment is “identified” that leaves significant uncertainty about the point at which the “60-day clock” will begin to run.
  • An extraordinarily lengthy 10-year “lookback” period for reporting.