Knowing Retention of Overpayments

The 2010 Patient Protection and Affordable Care Act (PPACA) made several significant amendments to the federal False Claims Act. One significant amendment is the requirement that hospitals, doctors, and other health agencies report any overpayment by Medicare or Medicaid within 60 days of “identifying” the overpayment. Medicare and Medicaid programs operate on such a large scale that accidental overpayments are an expected event. While hospitals and doctors were always technically supposed to return the money, the PPACA makes the repayment an affirmative obligation and exposes hospitals and doctors the FCA’s fines, treble damages, and other penalties.

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