Healthcare Compliance Perspective:
Overpayments, received for whatever reason, must not only be returned to the payer but also automatically become false claims after 60 days of knowing about the overpayment.
The NY Visiting Nurse Service and its managed long-term care plan will pay almost $4.4 million to resolve allegations that the plan improperly obtained public funds, and knowingly retained over $1.6 million in Medicaid overpayments. The service provider failed to identify and dis-enroll 365 members in a timely manner, and continued to receive payment for the non-provided care. Although the service ultimately dis-enrolled the members, it did not repay Medicaid for the improperly received funds within the 60-day legally required timeframe.
