Blog | Monday, March 5, 2012

QD: News Every Day--Medicare proposed going back 10 years for overbilling

Medicare has proposed going back 10 years to collect overpayments, longer than current time periods required to maintain medical records.

A proposed rule was published in the Federal Register, setting up a 60-day public comment period that expires April 14. (To comment, click here and follow the instructions.)

The overbilling recovery proposal leads to a question about how long must medical records be retained. For most treatment settings and other Medicare and Medicaid programs, it's five years. Health Information Portability and Accountability compliance required six years.

The proposed rule reads, "We selected 10 years because this is the outer limit of the False Claims Act statute of limitations. We believe that the proposed 10-year lookback period is appropriate for several reasons. First, we believe that providers and suppliers should have certainty after a reasonable period that they can close their books and not have ongoing liability associated with an overpayment. We also believe that the length of the lookback period is long enough to sufficiently further our interest in ensuring that overpayments are timely returned to the Medicare Trust Funds."

These paybacks involve mistakes, not fraud.

In case you missed it ...
There's been plenty of high-profile cases of Medicare fraud, recently. Seven people were indicted for overbilling Medicare and Medicaid $374 million in services that were unneeded or were not provided.

Investigative news reporters have set up their own sting, against another physician in Texas as well, issuing a scathing news report of their own, leading health care guru Atul Gawande, MD, MPH, to publically scold. Here's the ABC news report, in which a TV producer's grandmother was sent into a physician's office.