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Patient Refunds

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What you need to know about reporting and returning over-payments in 60 days or risk the false claims act.

The Patient Protection/Affordable Care Act of 2010 (PPACA) has a new deadline of 60 days to report and return over-payments to Medicare and Medicaid contractors. If providers to not do this then they risk violating the False Claims Act (FCA). The FCA became even more important in 2009 by President Obama when he signed the Fraud Enforcement and Recovery Act (FERA) that contained new FCA amendments. These amendments reversed the false claim provision saying that the entity violates FCA.

Currently this is how the 60 day deadline is stated in Section 6402 in PPACA

Over-payment needs to be reported and returned by the later of:

  • The date that is 60 days after the date of which the over-payment was identified as.

  • The date any corresponding cost report is due if applicable.

How is the date of which it was identified being define?

  • the overpayment has not been identified until the provider has absolutely concluded that an overpayment has occurred and has determined the amount of the overpayment.

  • The 60 days applies to the time after the amount of the overpayment has been determined, this gives those processing the returns the proper amount of time to review records and report and return the overpayment.

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