Lexology January 10, 2025
On January 1, 2025, the Centers for Medicare and Medicaid Services’ (“CMS”) new 60-Day Rule became effective. The 60-Day Rule states several changes, with some changes significantly impacting False Claims Act (“FCA”) liability.
Background
CMS’s 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to report and return identified Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply can result in liability under the FCA. The rule is codified at 42 U.S.C. § 1320a-7k(d).
Key Updates
Specific to the FCA, the updated rule makes three significant changes: (1) the rule updates the standard for determining when an overpayment is “identified;” (2) the rule imposes the obligation to...
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