Special Statutory Provisions related to Clinical R Are there any penalties or enforcement actions for providers who retain identified overpayments beyond the 60-day refund window?Yes, the statutory requirement under the Affordable Care Act to refund overpayments within 60 days of identification creates potential fines and penalties under the False Claims Act and Civil Monetary Penalties Law for failure to report and return the overpayment(s). For each overpaid claim, the government may be able to seek recovery of three times the claims value and a civil monetary penalty of up to $11,000. Failure to act (perform an inquiry as to the overpayment) with deliberate speed on the part of the provider, could result in the provider knowingly retaining an overpayment, and may result in exclusion from participation in the federal health care programs.5 | |
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