New rule fueling more false claims cases

A rule released earlier this year by the Centers for Medicare & Medicaid Services targeting overpayments may lead to an increase in cases involving the regulation, law experts say.

The new CMS Medicare overpayments rule, released in February, requires providers to return excessive reimbursements within 60 days of identifying them, as mandated by the Affordable Care Act.

In the wake of the CMS overpayment rule and a New York hospital group's recent $2.95 million settlement of “reverse false claims” allegations (a whistleblower claimed the group kept $844,000 in Medicaid overpayments past the required 60 days) many suspect the number of issues and cases relating to the 60-day rule will rise.

“I see no reason to think that litigation won't increase on 60-day rule and reverse false claims allegations,” Tony Maida, an attorney with McDermott Will & Emery LLP, told Bloomberg BNA

To avoid lawsuits or investigations into overpayments, “providers clearly have a duty to establish and conduct a rigorous compliance program that enables overpayments to be identified, quantified, reported and refunded,” said attorney Kenneth Marcus.