The health care industry will have to wait a bit longer for the much-anticipated CMS final rule on overpayment reporting. On Feb. 17, 2015, CMS announced that it will delay publication of the Final Rule to February 16, 2016, citing “significant policy and operational issues” raised by commenters to the Proposed Rule that require further collaboration with the Department of Justice and Department of Health and Human Services’ Office of the Inspector General.
The Proposed Rule, originally published on February 16, 2012, seeks to implement section 6402(a) of the Affordable Care Act entitled “Reporting and Returning of Overpayments.” Section 6402(a) requires overpayment recipients to report and return any overpayments, including a written explanation of the reason for the overpayment, by the later of (a) 60 days after the date on which the overpayment was identified or (b) the date any corresponding cost report is due. The Proposed Rule addresses several key implementation issues, including the definition of “identification,” clarification of reporting and returning deadlines, proposed look-back periods, and the interplay between the reporting rules and CMS and OIG self-disclosure protocols.
The sheer volume of comments received in response to the Proposed Rule reflects the industry’s strong need for clarity concerning its overpayment obligations. Nonetheless, in its February 15 continuation notice, CMS reminds stakeholders that delay of the final regulation does not relieve them of their statutory obligation to return and report overpayments and that failure to do so exposes them to potential liability under the False Claims Act and Civil Monetary Penalties law as well as exclusion from federal health care programs.