Overpayment Rule

42 U.S. Code § 1320(7)(d) - Medicare and Medicaid program integrity provisions (d) Reporting and returning of overpayments (1) In general If a [person](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) has received an [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k), the[ person ](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)shall— (A) report and return the [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) to the[ Secretary,](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1264422296-1615532608&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) the[ State,](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-80204913-1615532603&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) an intermediary, a carrier, or a contractor, as appropriate, at the correct address; and (B) notify the [Secretary](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1264422296-1615532608&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k), [State](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-80204913-1615532603&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k), intermediary, carrier, or contractor to whom the [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) was returned in writing of the reason for the [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k). (2) Deadline for reporting and returning overpayments An [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) must be reported and returned under paragraph (1) by the later of— the date which is 60 days after the date on which the [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) was identified; or the date any corresponding cost report is due, if applicable. (3) Enforcement Any [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) retained by a[ person ](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)after the deadline for reporting and returning the [overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) under paragraph (2) is an[ obligation ](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-389535362-923380433&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)(as defined in [section 3729(b)(3) of title 31](https://www.law.cornell.edu/uscode/text/31/3729)) for purposes of section 3729 of such title. (4) Definitions In this subsection: Knowing and knowingly The terms “[knowing](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-565986953-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)” and “[knowingly](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1547388228-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)” have the meaning given those terms in [section 3729(b) of title 31](https://www.law.cornell.edu/uscode/text/31/3729). (B) Overpayment The term “[overpayment](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-1150968142-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)” means any funds that a[ person ](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)receives or retains under subchapter XVIII or XIX to which the[ person,](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k) after applicable reconciliation, is not entitled under such subchapter. (C) Person (i) In general The term “[person](https://www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=42-USC-991716523-1430756802&term_occur=999&term_src=title:42:chapter:7:subchapter:XI:part:A:section:1320a%E2%80%937k)” means a provider of services, supplier, medicaid managed care organization (as defined in [section 1396b(m)(1)(A) of this title](https://www.law.cornell.edu/uscode/text/42/1396b)), Medicare Advantage organization (as defined in [section 1395w–28(a)(1) of this title](https://www.law.cornell.edu/uscode/text/42/1395w%E2%80%9328)), or PDP sponsor (as defined in [section 1395w–151(a)(13) of this title](https://www.law.cornell.edu/uscode/text/42/1395w%E2%80%93151)). (ii)Exclusion Such term does not include a beneficiary.