Noridian, CGS and the “60 Day Rule”

Thu, 10/25/2018 - 2:00pm
Registration is free but limited to 100 participants

Presented by:

Jeffrey S. Baird, Esq., Brown & Fortunato, P.C.
Wayne van Halem, President, The van Halem Group
Noridian and CGS have recently sent letters to PAP resuppliers advising them to review PAP resupply claims submitted during the previous six years to determine if overpayments exist. The letter further advises resuppliers to either (i) review every file or (ii) use statistical analysis to determine a valid sample that can be extrapolated into the universe. The letter then tells the resuppliers that that they will have 180 days to review and identify overpayments and then to refund the overpayments within 60 days thereafter. What makes these letters so alarming is the fact that they are setting up the resuppliers for False Claims Act liability. Pursuant to the Affordable Care Act and implementing regulations, if a provider/supplier identifies an overpayment and does not repay it, then the overpayment becomes a “false claim,” thereby triggering civil monetary penalties. As such, it is critical that the recipients of the letters take proactive steps to respond. There is a likelihood that similar letters, pertaining to other types of products, will be sent to DME suppliers in the future. This webinar will discuss (i) the reasons that the Noridian and CGS letters were sent, (ii) how the letters trigger potential liability under the False Claims Act, (iii) the responsive steps that recipients of the letters should take, and (iv) why the letters will likely be “a sign of things to come.”