In the final 2025 Medicare Physician Fee Schedule, which is set to be published in the Federal Register on December 9, the Centers for Medicare and Medicaid Services (CMS) included substantive changes to the regulations governing when a provider must report and return a Medicare overpayment in order to avoid liability under the False Claims Act (FCA).

In a recent client alert, we detail the changes to the overpayment regulations. These include bringing the definition of an overpayment into line with the FCA knowledge standard and codifying a suspension of the required 60 day refund period for initial findings of an overpayment obligation during an up to a six-month period of good-faith investigation that will allow Medicare Part A and Part B providers to examine their records and determine if they received any related overpayments that will also need to be addressed.

The rule, which takes effect on January 1, 2025, is within the window of rules that could be examined by the new Congress or rescinded by the incoming administration. However, we think that the nature of the changes and reasons for those changes would make that unlikely.

Reed Smith will continue to follow developments with regard to the False Claims Act and Medicare regulations. If you have any questions, please do not hesitate to reach out to the health care lawyers at Reed Smith.