When should you return overpayments directly?
Ryan Meade, a health care attorney with Katten Muchin in Chicago, says the following considerations weigh in favor of direct returns:
- Did the error occur for a very short period of time?
- Is the error isolated to specific claims identified in the compliance review?
- Does the error appear to be random, with no identifiable pattern and confined to the specific claims identified in the compliance review?
- Is the amount of return small compared to the provider’s overall revenue from the health program receiving the refund?
- Is the amount of overpayment needing to be returned similar in size to the provider’s other recent refunds?
- Does the provider have a good working relationship with the intermediary or carrier who will receive the refund?
- If the overpayment is sizable, is this refund the first significant refund? If the provider has been the subject of recent qui tam suits, government investigations, or has made sizable self-disclosures recently, then it may be more appropriate to self-disclose to the OIG or DOJ, Meade cautions.
- Is the provider satisfied that there is no known qui tam relator?
Ortquist says it’s possible to build effective working relationships with people at the FIs who are responsible for processing overpayments. "I encourage anybody in a compliance role to make efforts to find out where those people are and work on building those relationships," he says.