Does the 60-Day Rule Apply to Overpayments That Providers Receive from Medicare Advantage and Medicaid Managed Care Plans?

• March 01, 2022

• Jesse A. Witten , Faegre Drinker Biddle & Reath LLP
• Steve Lokensgard , Faegre Drinker Biddle & Reath LLP

The recent decision in United States v. Walgreen Co.,¹ has attracted attention because of its robust application of the False Claims Act’s (FCA’s) materiality requirement. The case is also noteworthy for an additional reason—the federal government’s embrace of the theory that the 60-Day Repayment Rule imposes FCA liability on providers that fail to refund overpayments received from Medicaid managed care plans. Similarly, the government has asserted in other litigation that a health care provider can also be liable under the FCA for failing to return overpayments from Medicare Advantage plans.²

ARTICLE TAGS

• Fraud and Compliance
• Government Reimbursement