The 60-Day Rule: What Healthcare Professionals Need to Know

The 60-day rule under the Affordable Care Act is one of the most important compliance regulations for healthcare providers accepting Medicare or Medicaid payments. It requires organizations to identify, report, and return any overpayments within 60 days of discovery. Failure to comply can lead to significant penalties, including potential False Claims Act liability. 

Why Does the 60-Day Rule Matter?

CMS introduced the final rule to ensure that improper Medicare and Medicaid payments are promptly corrected. The rule applies to hospitals, physician groups, skilled nursing facilities, and other healthcare providers. If an overpayment is identified but not addressed within 60 days, it can be considered knowingly retaining an overpayment, exposing providers to legal action. 

What Happens If You Don’t Comply?

Non-compliance can have serious financial and legal consequences, including: 

• Civil monetary penalties 
• False Claims Act liability 
• Exclusion from federal healthcare programs 

What’s New with the 60-Day Rule?

Recent updates have clarified key compliance expectations, including what constitutes identification of an overpayment and how providers should proactively investigate potential overpayments. These changes underscore the need for strong compliance programs and internal audit processes. 

Join our webinar to gain a deeper understanding of the 60-day rule’s impact, compliance strategies, and recent updates.