This presentation will provide a general overview related to the process of disclosing self-identified Medicare overpayments. More specifically, it will walk attendees through the current regulatory framework governing reporting and returning obligations.
Additionally, discussion will also include insights on how to conduct an internal review and the decisions involved such as determining when to report and where to disclose.
Historically, providers and suppliers enrolled in federal government healthcare programs have reconciled and returned overpayments through various post-payment audits.
Additionally, these same entities have voluntarily returned self-identified overpayment through various self-disclosure methods made available to them. When Congress passed the Fraud Enforcement Recovery Act of 2009 ("FERA"), these self-identified disclosures went from strongly encouraged to a mandatory obligation. FERA took the position that to keep the money constituted a "reverse false claim" under the False Claims Act (FCA) (31 U.S.C. 3729-3733).
Additionally, new repayment obligations surfaced with the passage of the Patient Protection and Affordable Care Act of 2010.
Learning Objectives:
- Overview of reporting and repayment obligations
- The Medicare 60-Day Overpayment Rule
- The OIG Self Disclosure Protocol
- The CMS Self-Referral Disclosure Protocol
- Strategies for conducting an internal review
- The reporting process
- The repayment process
- Questions and answers
Why Should You Attend:
If a Medicare participating provider or supplier fails to report and return an overpayment, the entity could face significant fines and penalties under the False Claims Act and the Civil Monetary Penalties Statute (42 U.SC. 1320a-7a). This presentation is designed to help guide you through the process to determine if you have an overpayment to help proactively protect your organization.
Instructor
Jay Anstine is the President of Bluebird Healthlaw Partners. As a healthcare lawyer specializing in regulatory compliance, Mr. Anstine consults to physicians, senior management and boards of directors on compliance programs and regulatory issues impacting operations.
Mr. Anstine's professional background includes working on the provider and the payer side of the market, for large for-profit and non-profit health systems and small physician-owned entities. In tackling the countless regulatory and operational issues for these diverse organization types, he has developed a deep understanding of the business of healthcare and the regulations that govern the industry.
Mr. Anstine obtained his law degree from the University of South Dakota where he focused exclusively on healthcare law. He currently serves on the Board of Directors for ClinicNET, a non-profit organization in Colorado that serves the medically underserved. He is also a member of the Health Care Compliance Association, serving on the planning committee for the Mountain Regional Conference.