The Spreadsheet Knew
Under 42 U.S.C. § 1320a-7k(d), a Medicare or Medicaid overpayment kept past the 60-day deadline becomes an obligation, and the reverse false claims provision reaches anyone who knowingly and improperly avoids such an obligation. CMS rules tie identification to False Claims Act knowledge, so an audit that has already calculated the overpayment becomes a record of what the organization knew. No false claim is needed. Keeping the money is enough.
Educational content. It is not legal advice. Andrew Hillman is not an attorney and works with retaining counsel.
Abstract
Two 2026 DOJ settlements show how an unfinished internal overpayment audit becomes a False Claims Act case under the 60-day overpayment rule. Covers the overpayment statute at 42 U.S.C. § 1320a-7k(d), the reverse false claims provision at 31 U.S.C. § 3729(a)(1)(G), and the CMS identification rules at 42 C.F.R. § 401.305 and § 422.326. Ends with an operator checklist for open review queues.
Indexed in OpenAlex under author A5139488776.
What happened in the Signal Diagnostics and AHF settlements?
How does the 60-day overpayment rule create a False Claims Act obligation?
How do CMS rules define when an overpayment is identified?
Does the 180-day investigation suspension apply to Medicare Advantage plans?
What should compliance teams check in their open review queues?
Sources
- 42 U.S.C. § 1320a-7k(d) (reporting and returning of overpayments)
- 31 U.S.C. § 3729 (False Claims Act, including (a)(1)(G) and (b)(1)(A))
- 42 CFR 401.305 (Medicare Parts A and B overpayments)
- 42 CFR 422.326 (Medicare Advantage overpayments)
- United States ex rel. Schutte v. SuperValu Inc., 598 U.S. 739 (2023)
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