REVISED RULES PROPOSED ON CIVIL MONETARY PENALTIES

https://www.federalregister.gov/articles/2014/05/12/2014-10394/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-the-office-of-inspector

REVISED RULES PROPOSED ON CIVIL MONETARY PENALTIES

The Office of the Inspector General (OIG) has published a proposed rule, seeking comments on revisions to the rules associated with Civil Monetary Penalties (CMP) for fraud and abuse. The Affordable Care Act significantly expanded OIG's authority to protect Federal healthcare programs from fraud and abuse. The proposed rule codifies the changes for:

• Failure to grant OIG timely access to records
• Ordering or prescribing while excluded
• Making false statements, omissions, or misrepresentations in an enrollment application
• Failure to report and return an overpayment
• Making or using a false record or statement that is material to a false or fraudulent claim

MDSC:  when you modify an MDS and it lowers the PPS RUG, that is an overpayment that must be returned to the treasury. There is no time limit on returning overpayments.