Health Law Blog - Healthcare Legal Issues

60 Day Repayment Rule Affordable Care Act

Overpayments and the Affordable Care Act

The Affordable Care Act mandates providers to return overpayments within 60 days after identification.  Failure to return known overpayments within 60 days of identification subjects the provider to possible claims under the False Claims Act.  Proposed regulations implementing the 60 day repayment rule was released in February of 2012 but have not yet been finalized.  Delays in finalizing regulation does not delay the effective date of the statute.

It is suggested that providers adopt policies to operationalize compliance with the repayment rules.  Providers who act in reckless disregard of overpayments can be subject to the draconian penalties imposed by the False Claims Act.  Reasonable compliance processes that are consistently followed provide the best defense if overpayments fall through the cracks.

Comments to the proposed repayment regulations strongly suggest that providers should take reasonable steps to self examine for potential overpayments.  In order to meet its obligations to take reasonable steps to identify overpayments, providers should adopt self audit and risk identification policies.  Those policies should be systematically followed.  Even though it may not be possible to identify every potential overpayment, the systematic adherence to policies and procedures that are reasonably calculated to identify potential problems in systematically identified areas where risk may occur.

For more information on the steps that you should follow to reduce your risk under the False Claims Act and overpayment statute, feel free to contact health care compliance attorney John Fisher.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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