4 facts practices need to know about Medicare overpayment rule

Practices that want to avoid having to pay False Claims Act (FCA) fines ranging from $5,500 to $11,000 per claim need to pay more attention to the Medicare payments they're receiving from the Centers for Medicare & Medicaid Services, reports Medscape.

That's because of a new final regulation on Medicare overpayments to physicians and other providers that requires them to be proactive in looking for overpayments and to pay them back. 

"Until now, doctors' only exposure to the problem of overpayment is when the billing company asks them to sign a refund check," Mick Raich, president of Blissfield, Michigan-based Stark Medical Auditing and Consulting, told the publication. "This regulation brings the issue to the front of the table."

Here are four facts and implications about the new rule that practices need to know:

  • As of March 14, practices must go through their books and repay any overpayment--even if it took place six years ago. That's the case, whether the overpayment is the fault of the payer or the provider, reports Medscape.
  • In addition to FCA fines, practices may have to pay up to three times the amount of damages sustained by the government, according to a CMS report cited in the article.
  • While the high fees for numerous violations and removal from the Medicare program could be a "death sentence" to a practice, physicians will be protected against these penalties--as long as they audit their books for overpayments, reports the publication. Practices typically have six months to investigate such billing errors and an additional 60 days to pay back the government, according to the article.
  • Practices must be proactive in reviewing their own billing records. Still, practices won't be required to develop a formal auditing or compliance plan, reports Medscape.

To learn more:
- read the article