CMS To Relax Medicare 60-Day Overpayment Rule

Monday, February 15, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health

On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule which eased requirements for health care providers to return overpayments within 60 days to avoid False Claims Act (FCA) liability. Under the rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received.

To read the final rule from CMS, click here.

Reducing the “Lookback Period.”

The rule includes a “lookback period” that requires providers who identify one overpayment to go back through their records and search for any other possible overpayments. Originally, regulators proposed a 10-year lookback period. Now, under this final rule, the lookback period has been reduced to a time frame of six years. According to CMS, six years is appropriate, matching the more common statute of limitations under the FCA.

The final rule states, “Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary in order to avoid imposing unreasonable additional burden or cost on providers and suppliers.”

Identifying an Overpayment.

Additionally, the final rule discusses methods available for reporting and returning identified overpayments to CMS. According to the rule, identification has occurred when a provider “has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the over payment.”    

Clarifying the Previous Rule.

The final rule has several differences from when it was first proposed in 2012. The rule sets to clarify requirements for the reporting and returning of self identified overpayments. The major provisions include clarifications around the topics mentioned above: the meaning of overpayment identification; the required “lookback period” for overpayment identification; and the methods available for reporting and returning identified overpayments to CMS.

To take a look at the original proposed rule from 2012, and see the differences, click here.

Failure to Report Overpayments Can Lead to Big Penalties.

Termination from the Medicare program can have devastating and far-reaching effects for health care professionals. What many licensed health care entities and their owners fail to understand is that if their participation in the Medicare program is terminated for cause, that is grounds for revocation of the entity's license. Furthermore, termination of the entity's license or Medicare provider status may also be grounds for revocation of the individual owner's professional license.
To read further on this topic, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations, False Claims Act cases and other Legal Proceedings.

It is extremely important that health care providers obtain experienced professional representation when dealing with Medicare overpayments to avoid violating the FCA. The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicare program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

We assist providers in obtaining Medicare and Medicaid provider status (provider identification numbers), as well as, in proceedings seeking to revoke or terminate a health care provider's Medicare and Medicaid provider status. We also advise clients on performing internal audits of Medicare and Medicaid services, billing, reimbursement and on how to make voluntary refunds of overpayments to the Medicare and Medicaid Programs.

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at


Overly, Jeff. “BREAKING: Medicare eases 60-day overpayment rule.” Law360. (February 11, 2016). Web.

Swann, James. “Medicare Overpayment Final Rule Clears OMB Review Process.” Bloomberg. (February 8, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealth The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone; (407) 331-6620.

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