From time to time I get questions about Medicare's voluntary overpayments rule.
If you think you have such a situation, you want to talk to compliance experts or e.g. a Medicare/healthcare attorney. I can give some general layman's background to where the policies are.
Section 1128J of the Social Security Act was added by the Affordable Care Act of 2010 (ACA). Online here. (See also 42 CFR 401.305 here). Stating in part,
In general.—If a person has received an overpayment, the person shall—CMS has a fact sheet about this from 2016, here. The full February 12, 2016 rule is here (81 FR 7654, 32pp). A law firm 3-page white paper is here. The section referring to MAC edits of LCDs, NCDs, is here.
(A) report and return the overpayment to the Secretary, the State, an intermediary, a carrier, or a contractor, as appropriate, at the correct address; and
(B) notify the Secretary, State, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.
(2) Deadline for reporting and returning overpayments.—An overpayment must be reported and returned under paragraph (1) by the later of—
(A) the date which is 60 days after the date on which the overpayment was identified; or
(B) the date any corresponding cost report is due, if applicable.
Good Cop, Bad Cop
Q&A during policymaking asked if some types of overpayments "not caused by the provider" should be excluded, such as "if the Medicare contractor pays for a non-covered service due to a contractor system edit problem" or "fails to implement a national or local coverage decision correctly." CMS answered that "we disagree" that any of those factors would override the repayment requirement. 81 FR 7657.
