False Claims Act suit could affect CMS overpayment rule

A complex argument over how to identify Medicaid overpayments could be why the Centers for Medicare & Medicaid Services postponed its pending rule on waiting periods for overpayment resolution, a Washington, DC, lawyer said Thursday.

CMS delayed the final ruling until Feb. 16, 2016, on an Affordable Care Act provision requiring the repayment of Medicare overpayments within 60 days.

A motion to dismiss was filed in U.S. District Court for the Southern District of New York in the case, United States ex rel. Kane v. HealthFirst, Inc., according to Bloomberg News services. The case alleges violations to the False Claims Act.

Last week, attorney Robert L. Roth told session attendees at the American Health Lawyers Association's Institute on Medicare and Medicaid Payment Issues that the pending outcome of the suit could partly explain why CMS is “having difficulty” finalizing the rule.

Meanwhile, many providers are using the agency's Self-Referral Disclosure Protocol (SRDP) to settle overpayments and mitigate liability, according to published reports.