Understanding “Credible Information”

Recently the HHS OIG identified $389,000 in overpayments throughout a four-year period in a recent audit of a New York hospital. The OIG recommended the hospital refund this amount to Medicare, but their recommendations certainly didn’t end there.

“OIG believes that this audit report constitutes credible information of potential overpayments. Upon receiving credible information of potential overpayments, providers must exercise reasonable diligence to identify overpayments (i.e., determine receipt of and quantify any overpayments) during a 6-year lookback period. Providers must report and return any identified overpayments by the later of (1) 60 days after identifying those overpayments or (2) the date that any corresponding cost report is due (if applicable). This is known as the 60-day rule.”

The Federal Register Final Rule of the 60-day overpayment regulation requires action whenever “credible information” of an overpayment is provided. And in case you’re wondering, yes, a hotline phone call can count as “credible information.”

Here’s where things get a little compounded; the Final Rule states that “if the provider fails to make any reasonable inquiry into the complaint, the provider may be found to have acted in reckless disregard or deliberate ignorance of any overpayment.” This could lead to liability under the False Claims Act.

Download our free eBrief, “The Overpayment Rule and Deciphering Credible Information,” to learn how to protect your organization from overpayments and false claims allegations. In this eBrief, you’ll learn the:

• Most Important Details of the Final Rule
• Serious Dangers of Inaction
• Definitions and Facts of “Credible Information”