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Navigating Treacherous Waters: Medicare’s Final Rule for Reporting and Returning Overpayments

In October 2010 a provision of the Affordable Care Act, Section 6402(a) amended the Social Security Act by inserting several “program integrity” elements into that law. The focus of those program integrity elements is Medicare providers and suppliers. 1 These new requirements provide direct statutory support of the long standing principle that participating providers must report and return to the Medicare Trust Fund any “unearned payments” they have received net of any applicable reconciliation. 2 A sixty-day time period was established for returning any monies received for such “overpayments.”

It soon became clear, however, that the language in this provision of the Affordable Care Act was deficient. This was principally due to a woeful lack of details regarding the “mechanics” of the process that providers were expected to follow in making overpayment returns and concerns over the length of time that providers would remain liable to repay Medicare for overpayments under this provision.

Two years later in 2012, CMS responded to the situation by publishing a set of “proposed final rules” governing overpayment reporting and recoveries. This proposed rule was designed to flesh in by way of regulatory guidelines the gaps in Section 6402(a) so that providers could better comply with the law.

To read the full whitepaper download here.