COMMENTARY

Medicare Overpayment; Older Doctors Sued; Health Benefits

Wayne J. Guglielmo, MA

Disclosures

March 16, 2012

In This Article

Don't Toss Your Medicare Financial Records

At a briefing in February, top government officials touted last year's $4.1 billion in healthcare fraud recoveries, a record amount. At the same briefing, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled a proposed rule that could help to boost this year's overpayment returns to Medicare.

According to a story on amednews.com, doctors under the proposed rule "would be given two months to return any money flagged as a Medicare overpayment from as far back as 10 years."[1]

The Centers for Medicare & Medicaid Services (CMS) has characterized both the 10-year "look-back" period and the 2-month time frame for returns as reasonable. They both permit providers to close their books after a certain date; on the other hand, says CMS, and help to ensure that past overpayments are returned to the Medicare Trust Funds in a timely manner.

But some health lawyers think that the 10-year window is far from reasonable. Most offices that identify a systemic billing problem aren't equipped to go back more than 6 years, Boston attorney Lawrence W. Vernaglia told amednews.com.

Vernaglia is less concerned about the 60-day repayment clock, because the proposed rule would permit doctors to inquire about possible overpayments before the repayment clock starts ticking. Still, physicians who fail to start an investigation in a timely manner or who drag out one that has already begun could run afoul of the federal regulation and face penalties.

Under the proposed rule, doctors who fail to report and return an overpayment may be subjected to a monetary fine and possible exclusion from federal health programs. Cases that raise possible violations of anti-kickback statutes may be referred for investigation to the Department of Health and Human Services Office of Inspector General.

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