Medicare Overpayment Final Rule Clears OMB Review Process

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By James Swann

Feb. 8 — The White House Office of Management and Budget has finished reviewing a final rule that establishes a time line for the reporting and return of Medicare overpayments.

The Centers for Medicare & Medicaid Services' final rule (RIN 0938-AQ58, CMS-6037-F), which was originally received by the OMB in October 2015, would implement Section 6402(a) of the Affordable Care Act, which requires health-care providers to repay an overpayment and to notify the federal government, the state and any “intermediary, carrier or contractor to whom the overpayment was returned in writing of the reason for the overpayment,” all within 60 days of first identifying the overpayment.

The final rule is intended to provide clarity on when providers must report and return Medicare overpayments once they've been identified. Providers who fail to heed the 60-day reporting and return window can face civil monetary penalties and incur False Claims Act liability.

The review was completed Feb. 5, according to the OMB's website, and is the final step before the rule is published. The proposed version was published in February 2012.

In addition to addressing how quickly providers and suppliers have to repay identified Medicare overpayments, the final rule would also establish a look-back period. The proposed rule included a 10-year look-back period, meaning that the CMS could review 10 years of claims for any additional overpayments on top of the original overpayment identified by the provider or supplier

The CMS was scheduled to release the final rule in February 2015 but delayed it a year due to the rule's complex nature .

In announcing the delay, the CMS stressed that providers could still face potential FCA Act liability and penalties for failing to report and return Medicare overpayments, despite the lack of a final rule.

To contact the reporter on this story: James Swann in Washington at

To contact the editor responsible for this story: Janey Cohen at

Request Health Care on Bloomberg Law