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Health care providers must report and return overpayments, NY Medicaid IG says

By Phillips & Cohen LLP

Reporting and returning overpayments from government health care programs will be the most important Medicaid program integrity issue in 2011, according to New York State Medicaid Inspector General Jim Sheehan

Sheehan told attendees at the Health Care Compliance Association's Physician Practice Compliance Conference that the Patient Protection and Affordable Care Act (PPACA) gives providers a maximum of 60 days after an overpayment is identified to report it, return it, and explain in writing the reason for the overpayment. If the overpayment is retained past that 60 day window, it is a false claim under PPACA. This brings it within the purview of the False Claims Act, and that act's penalties and whistleblower provisions come into play.

Sheehan said that government auditors will also be looking more carefully at orders signed by doctors for durable medical equipment, home health care, and other supplies and services. They will be looking "behind the order" to determine if the service or supply was medically necessary.

Sheehan was quoted in BNA's Health Law Reporter (subscription required).

Full post as published by False Claims Act - Qui Tam on October 25, 2010 (boomark / email).