In December 2022, the Center for Medicare and Medicaid Services (CMS) unexpectedly issued a proposed rule that would materially change the obligations of entities participating in the Medicare program to report and return overpayments of Medicare Part A and Part B funds. The proposed rule would revert to the definition of "identified" that CMS originally proposed in 2012 and removes the concept of quantification of the overpayment serving as the start of the 60-day clock.
IN DEPTH
Rather than allow Part A and Part B providers and suppliers time to conduct "reasonable diligence" before determining that an overpayment has occurred and to quantify the amount of the overpayment, as set forth in the current overpayment refund rule at 42 C.F.R. ' 401.305, the new proposed rule would require that Part A and Part B overpayments be reported and returned within 60 days of the provider or supplier having actual knowledge, or being in reckless disregard or deliberate ignorance, of the existence of the overpayment. Under the current rule, providers and suppliers that become aware that a potential overpayment may have occurred are expected to investigate the existence of the overpayment and...
