Medicare and Medicaid Repayments and Disclosures
Meeting Refund and Reporting Obligations to Comply With Regulatory Requirements
A live 90-minute CLE video webinar with interactive Q&A
This CLE course will guide healthcare counsel on the legal obligations, benefits, incentives, and risks of reporting and repaying improper Medicare and Medicaid payments. The panel will offer best practices for complying with the requirements for reporting and returning overpayments.
Outline
- Medicare requirements for overpayment
- Benefits, incentives, risk of disclosure
- Best practices for investigating and responding to potential overpayments
Benefits
The panel will review these and other key issues:
- What are the obligations concerning potential overpayments?
- What are the benefits and incentives for refunding and disclosing overpayments? What are the risks?
- What factors should healthcare providers consider when determining where to make a disclosure?
- Practical considerations when investigating potential overpayments, including when performing audits, analyzing error rates, and using statistical sampling
- The effect of the 60-day refund statute on overpayments involving Medicaid, Medicare Advantage, and Medicaid Managed Care plans
Faculty
Bridget A. Gordon
Partner, Co-Chair Clinical Laboratory Work Group
Hooper, Lundy & Bookman
Ms. Gordon’s practice is focused on managed care litigation, fraud and abuse matters, inclusive of False... | Read More
Ms. Gordon’s practice is focused on managed care litigation, fraud and abuse matters, inclusive of False Claims Act litigation, managed care contract review, and compliance advising. She has handled a wide array of reimbursement disputes with both commercial and government payors, for both contracted and non-contracted providers. Such disputes also include challenging and responding to payor audits, recoupment requests, and investigations. Ms. Gordon also frequently handles Medicare appeals and ALJ hearings, Targeted Probe and Education audits, Comprehensive Error Rate Testing denials and appeals, and Uniform Program Integrity audits. She routinely defends providers in healthcare fraud and abuse matters ranging from assistance and strategy with responses to Civil Investigative Demands and subpoenas issued by DOJ, OIG, the Department of Insurance, and other governmental entities, to defending providers in qui tam relator actions, False Claims Act actions, and related actions brought under various state laws such as the Insurance Fraud Prevention Act. She also works closely with clients on managed care contract review and negotiation, as well as compliance advising and internal policy development. Ms. Gordon also has substantial experience in the long-term care space, related to both fraud and abuse matters, as well as citation appeals. She has also regularly handled internal audits and investigations and government agency audits, for a variety of healthcare provider types. Ms. Gordon’s practice comprises both providing effective representation for clients in disputes and providing strategic counsel and guidance concerning regulatory issues and actions. With respect to the former, she has handled dozens of matters through arbitration, mediation, before administrative panels, and in courtroom litigation both at the state and federal level.
CloseEarly Discount (through 07/11/25)