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4 Harris County Physician Newsletter %u2022 February 2025 %u2022 www.hcms.orgManaging overpaymentsPhysicians must establish clear and consistent procedures to identify and process overpayments in their practice. If not properly managed, overpayments can result in substantial fines, criminal prosecution, and disciplinary action by the Texas Medical Board. This article outlines some considerations physicians should be aware of when handling overpayments. Medicare and MedicaidOn Nov. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) revised the %u201c60-Day Refund Rule,%u201d which impacts physicians%u2019 obligations regarding Medicare and Medicaid overpayments. The rule requires that overpayments be reported and returned within 60 days of identification. However, physicians can suspend this 60-day deadline under certain conditions. The new rule, effective Jan. 1, 2025, allows for an extended period if an overpayment has been %u201cidentified%u201d (defined using the False Claims Act definition of %u201cknowingly%u201d) and the physician conducts a %u201ctimely, good-faith investigation%u201d to determine the existence and amount of overpayments. The 60-day clock for reporting and returning overpayments will be suspended until: %u2022 The date that the investigation of related overpayments has concluded, andthe aggregate amount of the initially identified overpayments and relatedoverpayments is calculated; or%u2022 The date that is 180 days after the date on which the initial overpayment wasidentified.If no investigation is undertaken, the overpayment must be returned within 60 days. Failing to comply with these regulations could lead to substantial civil penalties%u2014up to $24,947 per overpayment. Furthermore, violations of the False Claims Act, https://bit.ly/USC3729, could result in additional penalties.To review the CMS rule, visit https://bit.ly/60dayrule.Patient/beneficiary:Under the Texas Insurance Code, found at bit.ly/ksfjlfj, overpayments must be refunded to a patient/beneficiary within 30 days of discovery, regardless of the amount involved. Failure to do so may result in penalties and interest from the%u00a0Texas Comptroller of Public Accounts, possible criminal charges relating to the conversion of property, and disciplinary action from the Texas Medical Board.%u00a0If the patient or beneficiary cannot be located, Texas law mandates that the overpayment must be submitted to the Texas Comptroller%u2019s unclaimed funds office at https://www.claimittexas.gov/. A written notice must also be sent to the beneficiary%u2019s last known address, if available. Commercial payers:A failure to return credit balances to a commercial insurer in a timely manner may constitute a breach of contract and recoupment of the overpayment and may also be considered %u201cconversion of property.%u201d Commercial payer agreements typically include provisions about how overpayments should be handled. Physicians should consult their contracts to ensure compliance with any specific procedures or timelines for returning overpayments to avoid legal or financial penalties. Visit our Recoupments, Refund Requests, and Managing Overpayments web page for more information at www.hcms.org/Recoupments. Presented by the HCMS Board on SocioeconomicsThe HCMS Employed Physicians page provides essential resources for anyone interested in employment or already employed. Considerations in evaluating an offer of employment include non-compete provisions, compensation arrangements, productivity requirements, and other provisions found in employment contracts. Resources for negotiating an employment agreement and a list of attorneys who offer employment contract review discounts can be found on our Employed Physicians page at www.hcms.org/EmployedPhysicians. Additionally, the TMA provides several practice model resources at https://bit.ly/40szEek. Contemplating employment?Please note that the content provided herein is INFORMATIONAL only, and should NOT, in any way, be considered legal, professional, business, practice, nor other advice.%u00a0Please consult your own adviser and/or attorney before taking any action or inaction based on this information and to also confirm that you are compliant with all applicable requirements and laws.