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 Sector Advocates Seek Shorter Lookback Period For Overpayments

 

 


Advocates of the long term and post-acute care profession have raised “grave concerns” about a 10-year lookback period for identifying Medicare overpayments, which the Centers for Medicare & Medicaid Services (CMS) proposed as part of a rule implementing a provision of the Accountable Care Act (ACA).

The ACA established new requirements for reporting and returning Medicare overpayments, but made no mention of a lookback period. CMS’ proposed rule would require the reporting and return of overpayments identified within 10 years of their receipt and allow contractors to reopen overpayment determinations as far back as 10 years. 

The imposition of such a lengthy lookback period “expands the already burdensome web of reporting requirements providers and suppliers face today,” said AHCA in formal 18-page comments. Furthermore, CMS’ proposal “escalates the complexity of various, inconsistent time periods providers have to retain records and report situations that could be considered an ‘overpayment,’ creates duplicative reporting obligations and processes, and further muddles how a Medicare provider or supplier is to proceed when faced with a situation that could be an overpayment,” AHCA said.

The CMS proposed rule, published Feb. 16 in the Federal Register, implements an ACA provision that requires the return of Medicare overpayments within 60 days of their discovery, or by the date of their corresponding cost report. Repayments that are not made within that time frame become “obligations” under the federal False Claims Act.

AHCA made nine recommendations for modifying CMS’ proposal in a way that balances the agency’s concerns and “the reality of the enormously burdensome nature of its proposals,” the comments said.
At the top of AHCA’s recommendations is a three-year lookback period, in place of the agency’s proposed 10-year window. 

AHCA’s comments pointed out that the ACA doesn’t suggest a lookback period, and that the time frame proposed by CMS correlates to the “outer limit of the False Claims Act statute of limitations,” inappropriately associating “simple overpayments” with false or fraudulent claims.

AHCA’s recommendations included:
■ Allowing existing protocol for self-disclosure and self-referral disclosure to fulfill reporting obligations;
■ Imposing reporting and repayment obligations only when an overpayment cannot be addressed in the normal course of business; and
■ Establishing that identification of an overpayment does not occur until a provider has determined all information required by CMS, including the amount of the overpayment.

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