Optional_2023 Board Resources

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Failure to (x) disclose required information or supply requested information on subcontractors and suppliers or (y) supply payment information to HHS or other inspecting agency (no minimum exclusion period); 88 Failure to grant immediate access to HHS or other inspecting agency (no minimum exclusion period); 89 Failure to take corrective action (no minimum exclusion period); 90 Default on health education loan or scholarship obligations (exclusion period no less than the period until default has been cured or obligations have been resolved); 91 Individuals controlling a sanctioned entity (exclusion period no less than the period of the entity’s exclusion); 92 Making a false statement or misrepresentation of material fact (no minimum exclusion period); 93 Failure to meet statutory obligations to provide medically necessary services (exclusion period no less than 1 year). 94 ARTICLE 6 60-DAY OVERPAYMENT RULE

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(m) (n)

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6.1 Description of Statute . The ACA created an express requirement to report and refund Medicaid and Medicare overpayments by 60 days after an overpayment is identified or the date upon which any corresponding cost report is due, whichever comes later. 95 CMS published final rules made concerning Medicare overpayments to implement the statute. 96 While CMS is yet to publish a rule implementing the statute in the context of Medicaid, it should be noted that the rule still applies to Medicaid overpayments. (a) Lookback Period . The obligation to report and return the payment only attaches if a person identifies the overpayment within 6 years of the date that the overpayment was received. 97 (b) Identification of Overpayment and Reasonable Diligence . Prior to the final rule by CMS, there was considerable confusion as to what “identification” of an overpayment meant. CMS has since clarified that an overpayment is identified when the recipient has, or should have through reasonable diligence, (x) determined that he received an overpayment and (y) quantified the amount of the overpayment; conversely, if the person receives an overpayment and also fails to exercise reasonable diligence, then the overpayment 88 42 U.S.C. § 1320a-7(b)(9-11). 89 42 U.S.C. § 1320a-7(b)(12). 90 42 U.S.C. § 1320a-7(b)(13). 91 42 U.S.C. § 1320a-7(b)(14). 92 42 U.S.C. § 1320a-7(b)(15). 93 42 U.S.C. § 1320a-7(b)(16). 94 42 U.S.C. § 1320c-5. 95 PPACA § 6402(a). 96 81 FR 7654 (Feb. 12, 2016)(Medicare Parts A and B); 79 FR 29844 (May 23, 2014)(Medicare Parts C and D). 97 81 FR at 7654.