Judith Waltz Comments on Provider Settlement After Self-Disclosure

Foley & Lardner LLP partner Judith Waltz commented on a recent settlement by a provider with the U.S. Department of Health and Human Services Office of Inspector General (OIG) in the Report on Medicare Compliance article, “After Self-Disclosure, Provider Settles Case Over Failure to Report, Return Overpayments.”

“The covered conduct sounds like it went on for the entire six-year period, which is a long time for an overpayment to linger without resolution,” Waltz said of the case, noting that the civil monetary penalty settlement only focused on the retention of the overpayment.

Waltz also questioned whether the 2025 revisions to the Centers for Medicaid & Medicare Services’ (CMS) 60-day rule might have influenced the provider’s earlier decision to self-disclose to the OIG rather than repay the Medicare Administrative Contractor directly. She highlighted that while under earlier rules providers faced a six-year lookback period for identifying and returning overpayment, the revised rules may allow for a shorter, four-year reopening period.

Waltz added that if CMS applies the False Claims Act knowledge standard, the lookback period can extend up to ten years.