According to final regulations
released by the Centers for Medicare and Medicaid Services (CMS) on February 11, 2016, physicians must actively look for overpayment through self-audits and other forms of research. Physicians have 60 days from the date of identification to return overpayments to Medicare.
These new regulations implement a provision of the Affordable Care Act that requires physicians, hospitals, and other healthcare providers to return overpayments that have been identified on their own. CMS stated that “Providers and suppliers have a clear duty to undertake proactive activities to determine if they have received an overpayment or risk liability for retaining such overpayment.”
While self-audits are not a new mandate from the government, this final regulation does specify that physicians are liable for reporting Medicare overpayments looking back 6 years and must return the overpayment to Medicare within 60 days of discovery. If a physician fails to return overpayment within the specified period of time, they could risk being sued by the government under the False Claims Act (FCA).
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