March 01, 2022

Does the 60-Day Rule Apply to Overpayments That Providers Receive From Medicare Advantage and Medicaid Managed Care Plans?

American Health Law Association

In a coauthored article for the American Health Law Association’s Health Law Connections publication, business litigation partner Jesse Witten and health care partner Steve Lokensgard address the issue of the 60-day rule, which requires the return and reporting of identified Medicare and Medicaid overpayments within 60 days of identification.

The authors outline how the 60-day rule applies to overpayments received by providers from traditional Medicare (Parts A and B) and traditional Medicaid and to overpayments received by Medicare Advantage Organizations from the government.

However, more than a decade after the enactment of the 60-day rule, Witten and Lokensgard state that considerable uncertainty remains as to whether it applies to overpayments received by providers from Medicare and Medicaid managed care organizations. They also survey the relevant laws and regulations and explain the position taken by the Department of Justice in litigation.

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