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Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

Healthcare Law Today

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

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Pennsylvania Man Excluded from All Federal Healthcare Programs for 22 Years 

Healthcare Compliance Blog

In March of 2022, in a related matter, the man pleaded guilty to Healthcare Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the US Department of Health and Human Services between 2016 and 2020. He is awaiting sentencing on those charges.

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2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

CMS.gov

Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. percent in 2016 to 35.54

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OIG Revises Self-Disclosure Protocol

Florida Health Care Law Firm

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.