Proposed Overpayment Reporting Requirements For MA And Part D Programs May Increase False Claims Act Liability

The Centers for Medicare & Medicaid Services continues to take an expansive view of the overpayment refund requirement, which in turn can give rise to False Claims Act liability for Medicare Advantage Organizations and Part D Plan Sponsors.

Among the proposals in the Centers for Medicare & Medicaid Services' (CMS's) proposed rule for the Medicare Advantage (MA) and Part D Programs (Proposed Rule) is its interpretation of the overpayment refund and reporting requirements from the Affordable Care Act (ACA) for MA Organizations and Part D Plan Sponsors (collectively, Plan Sponsors).  The Proposed Rule does not apply directly to health care providers; an earlier 2012 proposed rule applied to Medicare Parts A and B (2012 A/B Proposal) but has not yet been released in final form.  The Proposed Rule, like the 2012 A/B Proposal, continues to take an expansive view of the overpayment refund requirement, which in turn can give rise to False Claims Act liability.