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Health Care Overpayments: Potential New Compliance Challenges for Medicare and Medicaid Providers Under the CMS's Proposed ''60-Day Rule'' Regulations



Tuesday, April 3, 2012
Product Code - lgn17
Speaker(s): Robert L. Roth, Hooper, Lundy & Bookman, P.C.; Paul A. Deeringer, Hooper, Lundy & Bookman, P.C.
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The so-called "60-Day Rule" under section 6402(a) of the Affordable Care Act requires health care providers, suppliers, and certain managed care entities who have received overpayments from government health care programs to report and return those overpayments by the later of “60 days after the date on which the overpayment was identified. . . or. . . the date any corresponding cost report is due.” Failure to comply with these requirements will result in stiff penalties under the federal Civil Monetary Penalty statute and potential liability under the federal civil False Claims Act.

Now, a proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) would increase compliance pressure for health care providers in reporting and returning overpayments for Medicare Part A and Part B items and services under the 60-Day Rule. The proposed rule would implement, among other things, a uniform standard for reporting and returning overpayments, a standard for determining when an overpayment is "identified," and a 10-year “lookback” period for analyzing potential overpayments.

Educational Objectives:

• Learn the penalties that one could incur from failure to comply with the proposed rule.

• Understand the uncertainties regarding determination of when an overpayment is "identified" under the proposed rule.

• Learn which items need to be included in a provider’s overpayment report.

• Learn why it is important for providers and others to comment on the proposed rule.

Who would benefit most from attending the program?

Health care providers, payers, in-house attorneys, compliance officers, hospital administrators, medical practice administrators, physicians.

Program Level: Intermediate

Robert L. Roth, Hooper, Lundy & Bookman, P.C.; Paul A. Deeringer, Hooper, Lundy & Bookman, P.C.

Robert L. Roth, Hooper, Lundy & Bookman, P.C.
Robert L. Roth, a partner with Hooper, Lundy & Bookman, P.C., in Washington, D.C., advises clients on matters arising under Medicare and Medicaid, focusing on payment, compliance, and licensing issues. A former senior attorney for the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), and a former Assistant Attorney General for the State of Maryland, Mr. Roth represents a wide range of clients on federal and state regulatory and business matters. He also represents clients in litigation at the state and federal trial and appellate court levels, as well as before state and federal administrative tribunals, including the Provider Reimbursement Review Board.

Mr. Roth represents providers and other clients throughout the country on matters such as reimbursement, overpayment refunds/disclosure, and coordination of benefits. He also actively counsels clients on complying with the issues surrounding all aspects of the Medicare/Medicaid programs, including the Medicare Secondary Payer (MSP) statute. Ranked by clients and peers as one of the leading health care attorneys in Washington, D.C. by Chambers USA, Mr. Roth was described as “zealous and committed” and as “stand[ing] out as having second-to-none knowledge of Medicare Secondary Payer issues.”

A frequent speaker and author on health law topics, Mr. Roth serves on the Advisory Board of Bloomberg BNA’s Health Law Reporter and Medicare Report and the CCH Medicare & Medicaid Guide. He has been teaching “Legislation” as an Adjunct Professor of Law at the University of Baltimore School of Law since 1984. In 2008, he served as a member of the Curriculum Review Committee for the Beazley Institute for Health Law and Policy at Loyola University Chicago School of Law. Mr. Roth earned an undergraduate degree from Lehigh University in history and Latin and J.D. from Syracuse University College of Law.

Paul A. Deeringer, Hooper, Lundy & Bookman, P.C.
Paul A. Deeringer is an associate in Hooper, Lundy & Bookman’s Business Department. Mr. Deeringer earned an A.B., summa cum laude, from Princeton University and a J.D. from Georgetown University Law Center, cum laude. Before joining Hooper, Lundy & Bookman in 2008, Mr. Deeringer was a management consultant for McKinsey & Company in McKinsey’s New York and San Francisco offices, serving exclusively health care clients, with a practice focused on corporate growth strategy and long-term strategic planning. Prior to practicing law, Mr. Deeringer was a Research Project Manager for the Health Technology Center (now the Center for Innovation and Technology in Public Health), a non-profit research organization whose mission is to create a trusted source of objective, expert and useful information about the future of health care technologies.

Mr. Deeringer’s practice involves health care-related business transactions and general corporate representation, including contracts between hospitals and physicians, the purchase and sale of facilities, and general corporate advice. Mr. Deeringer also advises clients on various regulatory issues. He represents clients before administrative agencies and all courts, with a particular emphasis on Medi-Cal reimbursement challenges in the long-term care and durable medical equipment industries. Mr. Deeringer has been heavily involved in the firm’s efforts to challenge the validity of the Medi-Cal Upper Billing Limit, 22 Cal. Code of Regulations 51008.1 (the “UBL”), and regularly counsels clients on UBL compliance issues.

This program is CLE-credit eligible.

If you have further questions regarding a specific state or how to file for CLE credit, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the Legal and Business CLE Accreditation Coordinator.

Hardship Policy
Bloomberg BNA offers a hardship policy for any attorney earning less than $30,000 per year. If an attorney wishes to take advantage of this option, he or she must do so in writing and also provide proof of hardship. If approval is granted, a discount of 50% off the full registration price of the program will be awarded.


Questions
For more information about Mandatory or Minimum Continuing Legal Education (MCLE) requirements, visit the American Bar Association website at http://www.abanet.org/cle/mandatory.html.

• Bloomberg BNA Subscriber - OnDemand format $199

• Non-Subscriber - OnDemand format $249

• CD recording of program $199 (Subscriber and Non-Subscriber)

 

Registration for Legal & Business programs is simple. You may either visit the registration page to register -or- call 1-800-372-1033, Option 6, and refer to the date and title of the program. Lines are open Monday through Friday from 8:00 a.m. to 8:00 p.m. ET.