Self-Reporting Is Your Escape Hatch for Medicare Overpayment

Money and stethoscopeThrough error, oversight, or good old-fashioned screw ups, let's say you're on the receiving end of a Medicare overpayment. What do you do? (Hint: The answer is not "new Porsche.")

It's also not "Let it slide and see if the government notices." They tend not to let these kinds of things go. In fact, the penalties for overpayment from the Centers for Medicare and Medicaid Services can be steep and painful-to the tune of triple the amount of the initial overpayment, plus a fine if it's found that a healthcare practice knowingly and deliberately held onto money that wasn't theirs.

That last bit, though, offers an out. The key is "deliberately." CMS is aware that mistakes happen. Fortunately, there's a system in place that allows providers to self-report, settle up their debts and stay out of regulatory crosshairs.

Overpayments can happen due to payments made for services that aren't covered; payments that are more than the allowable amount for a covered service; duplicate payments; or payments where some agency other than CMS was supposed to foot the bill.

When an overpayment is recorded, CMS will send notification. That means you're now on the hook to do your due diligence in a timely fashion. Once your institution has-or can be presumed that it should have-determined it received an overpayment (at most, after a six-month investigation), and quantified that amount, the clock starts ticking.

Practices have 60 days to remit overpayment to the Department of Health and Human Services secretary, an intermediary, carrier or Medicare contractor. Overpayments can be reported and returned using the Office of the Inspector General's self-disclosure protocol.

These steps are there to protect you (remember those fines?), but the best bet is to remain vigilant. Establish an internal collection process. Set your own guidelines for investigating overpayments, and track them. Or if you think you should retain counsel, Ideal Business Partners has your back.