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Chapter 6. The Medicare and Medicaid Overpayment 60-Day Report and Return Statute

The 60-day overpayment report and return statute imposes requirements on providers to identify, report, and return Medicare and Medicaid overpayments.[3] (Note: For ease of reference, this chapter refers to both providers and suppliers as “providers.”) Enacted in 2010, section 6402(a) of the Patient Protection and Affordable Care Act (ACA) included the statute (the 60-day statute).[4] (Note: The statute is sometimes also referenced as the “60-day rule.” For purposes of distinguishing between the statute and the implementing regulations with respect to Medicare Parts A and B in this chapter, the terms “60-day statute” and “60-day final rule” are used.) The statute requires providers, Medicare Advantage organizations, prescription drug plan sponsors, and Medicaid managed care organizations to report and return Medicare and Medicaid overpayments within the later of (a) 60 days after an overpayment is identified or (b) the date that any corresponding cost report is due (if applicable).[5] As specifically noted in the ACA, overpayments held beyond 60 days can be the source of liability under the False Claims Act (FCA).

Implementing regulations established after passage of the statute add significant detail regarding compliance, which providers might not divine from review of the statute alone. For example, in the final rule with respect to Medicare Parts A and B overpayments and corresponding preamble (the 60-day final rule), the Centers for Medicare & Medicaid Services (CMS) imposed requirements of “proactive compliance” and “reasonable diligence.”[6] Introduction of these requirements, with limited guidance regarding their application, can make it challenging for providers to determine what is required of them to reduce compliance risk.

This chapter focuses on applicability to providers of the 60-day statute with respect to overpayments arising under Medicare Parts A and B, providing an overview of the legal requirements along with practical compliance tips in an area where nuanced judgments may need to be made.

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