The “60-Day Rule” – The Affordable Care Act’s Obligation to Report and Repay Overpayments

Before Section 6402 of the Affordable Care Act (ACA) and subsequent regulations, if a DME supplier discovered that some of its past claims should not have been paid because of documentation deficiencies and/or other reasons, it was not uncommon for the supplier to fix the problem from a “go forward” standpoint and not worry about what happened in the past.  However, after the ACA, that is no longer an option.  In accordance with ACA, if any provider or supplier becomes aware of an overpayment (or should have become aware of an overpayment), it has six months to investigate and quantify the overpayment.  Thereafter, the supplier has 60 days to repay the overpayment.  Failure to do so may result in civil monetary penalties under the federal False Claims Act.  This program will discuss the “60-Day Rule” and the obligations it places on suppliers.  In particular, the program will discuss the six-year lookback period and what “should have become aware” means.  Lastly, the program will discuss how a supplier can properly investigate and quantify past claims that should never have been paid.

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