The federal government’s system for paying health care providers for services rendered to Medicare and Medicaid beneficiaries is a bureaucracy in and of itself.  It has also been well-known to be prone to mistake, with overpayments paid to providers totaling millions of dollars.  However, there was no requirement under any law for a provider to return those overpayments even though it seems like the obvious “right” thing to do.  Congress closed the loophole on this issue when it passed the Patient Protection and Affordable Care Act (“ACA”).  Under the ACA, any person, including a provider of services, supplier, Medicaid managed care organization, Medicare Advantage organization or PDP sponsor must report and return an overpayment from Medicare or Medicaid within 60 days after it is identified or after the date of any corresponding cost report, whichever is later.  The ACA also provides that any overpayment retained after this deadline is an “obligation” to the government for purposes of the False Claims Act.  Thus, Congress created False Claims Act liability for any provider that retains an overpayment for more than 60 days.

Congress’ message in passing this new law is clear.  The federal government may pay out billions of dollars in health care claims every year, but its payment systems are not perfect and responsibility for monitoring the accuracy of those payments lies with the providers who do business with the government.  Under the new law an overpayment is any payment by a federal entity to a provider or supplier in excess of what was due and payable.  It may be received through an innocent billing error or through a mistake of the contractor.  While the obligation for health care providers to report and return these overpayments is new, the overpayment practice has been ongoing for years.  Beginning May 24, 2010 when this law went into effect these payments are no longer windfalls.  They clearly raise False Claims Act liability for any provider who does not return them. 

If you believe someone has knowingly retained any overpayment from the federal government, and you would like more information about how this may be the grounds for bringing a whistleblower lawsuit, the qui tam lawyers at Keller Grover LLP can help you.  The whistleblower lawyers at Keller Grover understand qui tam litigation, including the whistleblower protection provisions, and strive to achieve the best possible results for their clients.