Overpayments and Voluntary Repayments Under the New 60-Day Rule.

Abstract

In 2010, with the passage of the Affordable Care Act, Congress created an obligation for healthcare providers to return overpayments that they receive within 60 days, or risk False Claims Act exposure. This year, CMS finally published regulations that clarify this statutory language. The regulations, however, impose strict standards on healthcare providers, wherein constructive knowledge can be imputed to a healthcare provider if that provider failed to exercise reasonable diligence. This article explores the new regulations, examines the practical implications of these new standards, and discusses the risks providers may face if they fail to engage in ongoing compliance efforts.