Hospitals would have to voluntarily return overpayments under new proposal

Even as officials announced record recoveries of fraudulent Medicare claims, they proposed new rules to force providers to voluntarily return overpayments within 60 days of discovering them. The proposal is intended to cut down on the need for criminal or civil investigations.

Modern Healthcare: New Overpayment Rules Proposed
The same day that federal officials unveiled record-breaking statistics on healthcare fraud enforcement, regulators announced the publication of new proposed rules designed to force doctors, hospitals and suppliers to voluntarily return overpayments within 60 days of discovering them. … HHS Secretary Kathleen Sebelius noted that the rules were intended to cut down on improper payments without the need for criminal or civil investigations (Carlson, 2/14).

Boston Globe: Federal Authorities Report Record Fraud Judgments, Settlements In 2011
Two cases highlighted in the report were linked to Massachusetts. In one case, Beth Israel Deaconess Medical Center paid $233,932 to resolve a case alleging that it overbilled Medicare for injections of a drug used to treat prostate cancer, using a billing code under which the hospital would be paid nearly twice what it should have been for the drug, called Lupron (Conaboy, 2/14).

CQ HealthBeat: Administration's Health Care Fraud Victories In Fiscal 2011 Similar To Previous Year
During the past fiscal year, federal officials won or negotiated about $2.4 billion in health care fraud judgments and settlements, according to an annual report released Tuesday. That total is slightly less than the $2.5 billion total for fiscal 2010. The federal report found that the amount of money deposited into federal accounts in fiscal 2011 because of anti-fraud efforts was the highest ever at $4.1 billion, as work from the past few years paid off in accumulated collections (Adams, 2/14).