Complying with the New Mechanics of the CMS “60-Day” Overpayment Rule
The Centers for Medicare and Medicaid Services (“CMS”) “60-Day” overpayment rule (“60-Day Rule”) was established as part of the Affordable Care Act (“ACA”) in 2010. [i] I n a nutshell, Section 1128J(d) [ii] of the ACA provides that a person who has received an overpayment shall report and return the overpayment to CMS [iii] in writing, stating the reason for the overpayment, within 60 days after the overpayment was identified (or the date the corresponding cost report is due). To encourage and enforce reporting of overpayments, Section 1128J(d) is clear that any improperly retained overpayments become a potential false claim under the False Claims Act (“FCA”). [iv] The obligation to return overpayments in a timely manner seems deceptively simple, but the mechanics of the process has been the subject of debate since it was enacted in 2010, and CMS again set forth regulatory direction for the 60-Day Rule on December 9, 2024. [v] This article sets forth the ...