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Retention of Overpayments

The federal government’s Medicare and Medicaid programs provide health insurance to more than 100 million Americans and collectively pay out billions in benefits each year. With government programs of this size and breadth, it is unsurprising that errors are made. Specifically, these programs regularly make overpayments to health care providers, who sometimes submit erroneous billing reports.

Before 2010, providers had no incentive for ever paying back the overpayments. They kept the windfall. Consequently, our government overpaid for health services to the tune of $60 billion a year.

Things changed with the passage of the Affordable Care Act. Congress created an affirmative duty on providers like hospitals and doctors to return any overpayment they knew about within 60 days. If they failed to, then they were subject to fines and penalties. A key penalty was treble damages—meaning that if a provider kept $1 million in overpayments, then they could have to pay back $3 million.

The False Claims Act & Retention of Overpayments

The False Claims Act, found at 31 U.S.C. §§ 3729-3733, was a law passed during the Civil War to protect the federal government from fraud. Specifically, the FCA made it illegal to submit a false claim for payment to the government or to refuse to pay an obligation owed.

Under the ACA, any overpayment retained past 60 days is now classified as an “obligation” for purposes of the False Claims Act, which means its retention is a violation of the law. The government can seek damages and penalties against the provider.

How You Can Help the Government Fight Fraud

Holding onto overpayments is a pretty clear case of fraud. Medical providers have an affirmative duty to pay back any overpayment they know about in a timely manner.

Unfortunately, the ACA has not forced all medical providers into compliance. Many of them continue to claim ignorance of overpayments, or they submit false cost reports which hide the overpayment. There is so much money at stake, some hospitals and providers feel pressure to keep the funds.

If you know about the illegal retention of overpayments, reach out to an Atlanta attorney today. Under the False Claims Act, you can bring a suit on behalf of the government for the money they are being defrauded by a health care provider.

For example, you might know that your hospital has kept $50 million in Medicare overpayments which, if true, would mean that the hospital could owe at least $150 million in treble damages. If you file a successful suit, you can receive a portion of the amount owed, typically 15-25%. The False Claims Act incentivizes ordinary Americans to blow the whistle on illegal conduct and possibly file a lawsuit themselves to claw the money back for the government.

Contact an Atlanta Retention of Overpayments Attorney Today

Although billing errors are a fact of life, holding onto overpayments knowingly can be a crime. If you would like to blow the whistle, contact Stacey Evans Law today to schedule a free consultation with one of our lawyers.

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