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On the heels of two similar settlements, a Baltimore health system has settled a case for $122,928 in which it was accused of getting the doctors whose practice it had acquired to bill established patients as if they were new, inflating their charges.

Perhaps human evolution someday will allow us to provide care to the souls of the deceased, but until that time comes, CMS had better shore up its claims allowances.

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. 

Did your practice participate in the Office of Medicare Hearings and Appeals’ settlement pilot project? If so, we’d love to hear the story of how your practice fared — regardless of whether it agreed to a settlement and got out of the massive backlog of appeals at the administrative law judge level.
Please contact editor Josh Poltilove at or (301) 287-2593.

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.


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