Legal Alerts/Details

CMS Proposes Changes to Medicare Overpayment Rules To Align With False Claims Act “Knowledge” Standard

January 10, 2023
  1. Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications, 87 Fed. Reg. 79452 (Dec. 27, 2022)., The Proposed Rule also includes provisions to increase beneficiary protections, especially with regards to plan marketing, access, and health equity.

  2. Pursuant to 31 USC § 3729(b)(1)(A), “knowingly” is when a person, with respect to information, “(i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information.”

  3. Medicare Part A covers inpatient hospital care, skilled nursing facilities, hospice, laboratory services, surgeries, and home health care. Medicare Part B covers services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and preventive services. 

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