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What to Do About Medicare Overpayments

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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.

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Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

John W. Sellers
John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena
Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Lynette S. Byrd
Lynette S. Byrd

Former Assistant U.S. Attorney

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Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (OIG)

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz

Former Supervisory Special Agent (FBI)

Chris Quick
Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan
Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern
Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

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 888-680-1745 or complete our online contact form today.

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