CMS Issues Final Rule on Returning Medicare and Medicaid Overpayments

Lexology February 26, 2025
Duane Morris LLP

Under the new rule, when the clock begins to run for providers to report and return overpayments—when an overpayment has been “identified”—has changed.

The Centers for Medicare & Medicaid Services (CMS) issued a Final Rule as part of the 2025 Physician Fee Schedule, which revises requirements for reporting and returning overpayments of Medicare and Medicaid funds. The Final Rule, which took effect January 1, 2025, amends CMS’s regulation interpreting the federal overpayment statute in two key ways:

• It revises the definition of when an overpayment is “identified” to trigger the 60-day return period; and
• Establishes a 180-day timeframe for investigating additional related overpayments.

The federal overpayment statute has long required any person who receives an overpayment of Medicare...

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