Medicare Overpayment Recoupment Lookback Period Extended to 5 Years

Posted on Health Care Law News by author

Included in the American Taxpayer Relief Act of 2012 were a number of changes to the Medicare program.  One change that could potentially have a significant impact in Medicare claims audits is an increase in the recoupment lookback period to 5 years from the prior 3 year rule.  This means that even absent an allegation of fraud, CMS can now reopen claims and collect overpayments up to 5 years after the year in which the claim was paid (potentially up to 6 years).

In the case of fraud, CMS can go back even further, including between 6 and 10 years under the federal False Claims Act.  In the proposed rule to implement the mandatory repayment obligations contain in the Affordable Care Act, CMS proposed a 10 year lookback period.  That proposed rule received a number of critical comments concerning the proposed lookback period, and it remains to be seen what the final rule will require.