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What to Do About Medicare Overpayments

audit results in medicare overpayment

One of the mistakes that organizations make involves Medicare overpayments, whether intentionally or accidentally. If, despite your best efforts to remain in ZPIC compliance, you find that you have received more money than you were owed for a Medicare claim, don’t panic. The world hasn’t ended.

The best thing to do if you’ve received a Medicare overpayment is to give back the extra money. You have 60 days from the date an overpayment is identified to repay the money. However, while it might be tempting to just keep the overpayment and ignore it, the consequences that might follow are usually not worth it. Instead, here’s what to do if you’ve received more than you should have.

Return What Doesn’t Belong to You

If you think you’ve received a Medicare overpayment, it’s usually best to consult your attorney immediately so you don’t make any mistakes. He or she will be able to review your documentation and ascertain whether you have, in fact, been given an overpayment. If you have, returning the extra money should be sufficient to absolve you of Medicare fraud suspicion.

Sometimes providers are granted overpayments through no fault of their own – but an honest provider returns the money. Keep in mind that there are severe consequences for Medicare fraud and keeping an overpayment can be considered fraudulent.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Attorney-at-Law & Founder

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Lynette S. Byrd
Lynette S. Byrd

Former Federal Prosecutor

Partner

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Subodh Chandra
Subodh Chandra

Former Federal Prosecutor

Local Counsel

Elizabeth K. Stepp
Elizabeth K. Stepp

Partner

Roger Bach
Roger Bach
(Non-Lawyer)

Former Special Agent, OIG

Dennis A. Wichern
Dennis A. Wichern
(Non-Lawyer)

Former Special Agent-in-Charge

Chris Quick
Chris Quick
(Non-Lawyer)

Former Special Agent, FBI

Kevin M. Sheridan
Kevin M. Sheridan
(Non-Lawyer)

Retired Supervisory Special Agent, FBI

Ray Yuen
Ray Yuen
(Non-Lawyer)

Former Supervisory Special Agent, FBI

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz
(Non-Lawyer)

Former Supervisory Special Agent, FBI

What to Do If You Find that the Money Should Be Yours

An overpayment doesn’t always mean fraudulent activity. It also doesn’t mean your business shouldn’t have received the higher payment. It’s possible you are entitled to the extra payment. If your attorney reviews the claim and finds that the evidence suggests that you’re owed the money you’ve been paid, you still have the right to appeal the denial of a claim.

Many providers think it’s best to simply pay back the money Medicare wants in order to resolve the case quickly. When it’s a small amount of money, it may seem easier just to fork it over than deal with the expense, trouble, and time of appealing the ZPIC’s denial.

However, allowing ZPIC to deny a claim that shouldn’t have been denied can reflect poorly on your organization. Every ZPIC denial raises your error rate, and the higher your error rate, the more likely you are to be audited in the future.

An Experienced Federal ZPIC Attorney Can Help; Contact the Trusted Team at Oberheiden, P.C.

Although you might not think something like an overpayment warrants a meeting with an attorney, it’s in your best interest and safer for your business to find out how to handle the extra money. It is never a good idea to just keep the overpayment without investigating why you have received it. And, to ensure you aren’t later charged with fraud, an attorney should investigate the details.

To learn more about a ZPIC compliance and Medicare payments, you can speak with one of our attorneys at Oberheiden, P.C.. For a free and confidential consultation, call (214) 692-2171 or complete our online contact form today.

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