AMA: Overpayment Rule May Force Record Hoarding

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  • March 16, 2012
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The U.S. Department of Health & Human Services (HHS) plans to collect overpayments within 60 days of discovery to bolster an ongoing assault on fraud and abuse, but the move may require practices to maintain patient records for 10, an American Medical Association (AMA) weekly publication, reports the proposed rule to mandate a 60-day improper recover period springs from the health reform law. The new regulation would penalize practices under the False Claims Act for not returning overpayments fast enough. It would also extend the looking-back period to 10 years, allowing auditors to report overpayments discovered 10 years from when the overpayment is received. This gives a practice the opportunity to investigate an allegation and define the scope of an inquiry, which can take months to complete. But failing to start an inquiry when warranted, or deliberately dragging out an investigation, would be considered reckless disregard under the federal regulation.
Physicians and other health professionals could face monetary fines and exclusion from federal health programs for failing to report and return an overpayment, the proposed rule states. Cases also could be referred to the HHS Office of Inspector General (OIG) for investigation of possible anti-kickback statute violations.
This announcement coincided with a report to Congress made by HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder detailing $4.1 billion in fraud and other health care recoveries in 2011, the largest ever.

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