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What to Do About Medicare Overpayments

Categories: Health Care Law

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.

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 (888) 727-5159 or complete our online contact form today.

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Health Care Practice Group has handled at least one hundred (100) matters in the health care industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence. For example, you need someone like Lynette S. Byrd, a former federal prosecutor in health care matters, who recently left the government and who is now sharing the valuable insights she gained as a health care prosecutor with our clients.

Dr. Nick Oberheiden

Dr. Nick

Lynette S. Byrd

Lynette S.