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CMS Changes Medicare Overpayment Notification Process

The Centers for Medicare and Medicaid Services (“CMS”) defines an overpayment as a payment to a provider or supplier that exceeds the amounts payable under Medicare statutes and regulations. If CMS identifies an overpayment made to a provider or supplier, it will initiate a recovery process for those identified overpayments.

CMS’ recovery process begins by sending the provider or supplier a demand letter, which requests overpayments it believes a provider or supplier wrongfully possesses. Typically, three notification letters are sent to providers/suppliers: (1) the demand letter, (2) a follow-up letter, and (3) an intent to refer letter.

Effective November 1, 2011, a second, follow-up letter (Day 30), will no longer be sent to providers/suppliers.

Those providers and suppliers receiving demand letters and wishing to appeal the audit decision should be prepared for part or all of this timeline
For more information on audits and appeals, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.

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