Last year, Congress amended the federal False Claims Act to close a “finders’ keepers” loophole, which had permitted health care providers to keep Medicare and Medicaid overpayments. Earlier this year, as part of the Health Care Reform Legislation, Congress set a 60-day time limit for providers to return these overpayments. Specifically, Section 6402 of the Patient Protection and Affordable Care Act gives providers a maximum of 60 days after an overpayment is identified to report it, return it, and explain in writing the reason for the overpayment. Thus, an overpayment retained longer than 60 days is now considered a false claim under the FCA.
FCA liability is triggered not by the receipt of overpayment but, instead, by the decision to retain an overpayment. In turn, while these amendments are not explicitly retroactive, potential FCA liability attaches to funds received prior to the amendments.
If you are aware of a health care provider who has made the conscious decision to keep a Medicare or Medicaid overpayment past 60 days, you may receive a substantial reward under the False Claims Act.
For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.