What to do if Medicare sends you too much money

It happens sometimes – you file a claim with Medicare and because of insufficient documentation, duplicate payments or administrative errors, you get paid too much money.

What happens next? Medicare usually asks you to pay the money back. But you do have options.

Standard operating procedure

When Medicare finds it has overpaid by $25 or more, an administrator sends a letter requesting repayment.

If you get such a letter, your options are to:

  • Repay the amount
  • Request immediate recoupment through offsetting future payments
  • Submit a rebuttal
  • Ask for a new determination of the amount so you can appeal the decision

Meanwhile, if your staff identifies an overpayment within the past six years, you are obligated by law to return the money within 60 days of finding the error. There is no minimum amount – all overpayments are to be repaid.

Rebuttal and appeal

Sometimes Medicare makes a mistake. When that happens, you can file for a rebuttal within 15 days of getting the letter from Medicare. In the rebuttal, you argue why you shouldn’t have to repay the money.

If you disagree with the decision about the overpayment, you can also file an appeal. There are five levels of appeals, including

  • Redetermination by an agent
  • Reconsideration by a qualified independent contractor
  • Hearing by an administrative law judge or attorney adjudicator
  • Review by the Medicare Appeals Council
  • Review in U.S. District Court

If you find yourself in an overpayment situation with Medicare, it’s in your best interest to get advice from a qualified, experienced attorney who knows how to handle Medicare claims.

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