Modern Healthcare (02/14/12) Carlson, Joe
Federal regulators have proposed new rules requiring healthcare providers to return any overpayments within 60 days of their discovery, and Department of Health and Human Services Secretary Kathleen Sebelius says the rules are designed to reduce overpayments without resorting to civil or criminal investigations. The proposal has courted controversy with some healthcare legal experts because it could potentially invoke provisions of the False Claims Act if healthcare providers knowingly withhold funds past 60 days. The rule says the clock would start ticking on the 60-day mandate when a person or organization possesses "actual knowledge" of an overpayment, or when the person acts in deliberate ignorance of the facts or with reckless disregard to them. Under the rule, organizations would not be required to find "proof of specific intent to defraud" in order to determine an overpayment and refund the money.

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