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State and federal prosecutors just landed a big settlement on an overpayments case against a major hospital chain and associated companies -- and it shows that at least one court takes the 60-day repayment window very seriously. 

Two Georgia dermatologists will pay nearly $2 million to settle charges that they unnecessarily stretched out simple procedures over several office visits – and billed E/M codes each time.

One of the few silver linings for providers in the final overpayments rule is that the “look-back” period within which CMS will go after provider overpayments was reduced to just six years. But that won’t necessarily stop federal prosecutors from going after them for longer.

Four years after the proposed rule was issued, CMS has issued the final 60-day overpayment rule, formally called Reporting and Returning of Overpayments. It reduces the look-back period within which the agency can act on determinations that providers have received too much in Medicare funds but sets rigorous standards for determining what an overpayment is – including “over-coded” E/M claims.

Practice management expert Lisa Maciejewski-West looks at the recently released 2016 OIG Work Plan and deduces that the Office of Inspector General (OIG) seems to have beaten back the big fraudsters -- and may be coming after you next.

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