Providers must report overpayments going back six years

Friday, February 12, 2016

WASHINGTON – CMS has revised the look-back period for overpayments from 10 to six years, according to a final rule issued Feb. 11.

Medicare Parts A and B healthcare providerswho discover Medicare overpayments within six years of the initial date reimbursementwas receivedmust report and repay them within 60 days to avoid liability under the False Claims Act, the rule states.

“Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary to avoid imposing unreasonable additional burden or cost on providers and suppliers,” the rule states.

CMS originally proposed a 10-year look-back period, aligning with the maximum window for bringing FCA lawsuits. However, upon further review, the agency says it believes six years reflects the more common statute of limitations under the FCA.

In the rule, CMS also clarified the meaning of “identification.” It says identification has occurred when a provider “has or should have, through the exercise of reasonable diligence, determined that the person has received and overpayment and quantified the amount of the overpayment.”

In the event of overpayment, providers and suppliers must use an applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to report and return overpayments. 

Providers are considered to be in compliance if they report a self-identified overpayment to the Self-Referral Disclosure Protocol managed by CMS or the Self-Disclosure Protocol managed by the Office of the Inspector General.