Overpayment Rule Stands: Review Your Plan’s Processes and Procedures Now to Avoid False Claims Act Liability

The Supreme Court recently denied a health plan’s petition related to the Centers for Medicare & Medicaid Service’s (CMS) Overpayment Rule, which requires Medicare Advantage (MA) organizations to return identified overpayments to CMS within 60 days.?In short, this means that the Overpayment Rule remains in effect and MA plans must comply or potentially face?False Claims Act?liability.?The Office of Inspector General (OIG) also audits plans for risk adjustment accuracy and overpayments.

While the Overpayment Rule has been around since 2014, the latest action serves as a good reminder that plans need to remain vigilant about accurate diagnosis coding. Though plans generally have measures in place (including reporting overpayments within the plan and to the plan’s CMS contact), it’s important to continue to identify instances of inaccurate coding and adopt practices to correct errors.

Given that the Overpayment Rule remains in force, it’s a great time to evaluate your practices and procedures aimed at mitigating errors and monitoring potential overpayments.

Does your plan need help navigating?the?complex requirements for returning self-identified overpayments??Contact John Gottwald, SVP, Client Services,?[email protected].?

Learn how our experts can guide your organization?with the the industry-proven models, processes and know-how needed to ensure compliance.