Lexology November 12, 2024
The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute). The result is a mixed bag.
In a qualified win for providers, CMS adopted a new definition of what it means to have “identified” an overpayment that triggers the 60-day report-and-return clock under the federal Overpayment Statute, finally abandoning its doomed “reasonable diligence” standard. On the other hand, CMS also codified a bright-line 180-day timeframe for conducting follow-on audits to investigate additional “related overpayments” that are suspected to “arise from the same or similar cause” as the initially identified overpayment.
As discussed herein, this often unrealistic 180-day allowance ultimately may be irreconcilable...
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