Providers must report and return identified overpayments within 60 days of identification or the date a corresponding cost report is due. Retention beyond that period creates an obligation constituting a reverse false claim under the False Claims Act.
Identification includes when the provider should have determined the overpayment through reasonable diligence.
Alternative Names:
Reverse False Claim, Sixty-Day Rule
Why it Matters?
The reasonable diligence standard is what makes this provision dangerous, because the clock can start before the provider actually quantified the overpayment. A compliance concern surfacing internally begins a period during which failing to investigate promptly can itself create liability. That converts a billing error into False Claims Act exposure with treble damages, which is why identified issues require documented investigation on a defined timeline.
Frequently Confused with
Related terms
Frequently asked questions
When does the sixty-day clock start?
Why is retention a False Claims Act issue?
