Wiki Refund time limit

[mcduffiegal]

Is there an article or Florida Statute that states the MC replacement plans have 6 years in which to ask for a refund from the provider?
I know Florida Statute 641.3155 states all but Medicare have 12 months to request.

 

[Pathos]

CMS MLN has an article that explains the following:

"When Medicare identifies an overpayment of $25 or more, your servicing Medicare Administrative Contractor (MAC) initiates the overpayment recovery process by sending an initial demand letter requesting repayment.
When you or your staff identify an overpayment within 6 years of the date the overpayment was received, generally referred to as the “look back period,” you must report and return the overpayment to Medicare as outlined in Section 1128J(d) of the Social Security Act (the Act) (as added by Section 6402 of the Affordable Care Act). You must return the overpayment by the later of 1) the date 60 days after having identified the overpayment or 2) the date any corresponding cost report is due, if applicable."

Also per Social Security Sec. 1893. [42 U.S.C. 1395ddd]:

"(f) Recovery of Overpayments.—

(1) Use of repayment plans.—

(A) In general.—If the repayment, within 30 days by a provider of services or supplier, of an overpayment under this title would constitute a hardship (as described in subparagraph (B)), subject to subparagraph (C), upon request of the provider of services or supplier the Secretary shall enter into a plan with the provider of services or supplier for the repayment (through offset or otherwise) of such overpayment over a period of at least 6 months but not longer than 3 years (or not longer than 5 years in the case of extreme hardship, as determined by the Secretary). Interest shall accrue on the balance through the period of repayment. Such plan shall meet terms and conditions determined to be appropriate by the Secretary."

I have a separate article that explains the time limit for CMS recoupment went up from 3 to 5 years.


I am interpreting all of this that CMS has 5 years to recoup back, but you as a provider has a responsibility to self-identify any overpayments up to 6 years.

 

[thomas7331]

I'd just add that Medicare replacement plans are outside of Florida state jurisdiction, so Florida statutes would have no bearing on the time limit for a replacement plan. States can only regulate fully insured health plans that are sold and operated within that state. Government plans and self-insured employee plans are not subject to individual state insurance regulations.