Court issues first False Claims Act 60-day repayment rule decision: 5 takeaways

The Department of Justice was issued a major win last week when a New York federal judge preserved a whistle-blower's False Claims Act lawsuit accusing several hospitals of violating the False Claims Act's 60-day overpayment provision, according to a Law360 report.

Here are five things to know about the 60-day repayment rule and the court's decision.

1. Under the 60-day repayment rule, any entity that receives an overpayment from the state or federal government must report the overpayment within 60 days of the date on which the overpayment was identified. Although the 60-day repayment rule went into effect about three years ago, cases based on violations of the rule began working their way through the system in 2014.

2. Robert P. Kane, a former employee of Continuum Health Partners — now part of New York's Mount Sinai Health System — served as the whistle-blower in the case. The Department of Justice also joined the lawsuit.

3. In February 2011, Mr. Kane sent his superiors a list of 900 billing claims that were possibly submitted in error. It took two years for Continuum to return the excess pay, according to the report.

4. In his decision, U.S. District Judge Edgardo Ramos said an overpayment is identified when a healthcare provider is put on notice of a possible overpayment, according to the report. "After Kane put defendants on notice of a set of claims likely to contain numerous overpayments, defendants had an established duty to report and return wrongly collected money," Judge Ramos wrote in his decision.

5. That ruling is the opposite of what the defendant hospitals had hoped for. They argued that the 60 days should begin running when a specific overpayment is pinpointed conclusively.

More articles on healthcare industry lawsuits:

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