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Physician Law Blog

We provide insights and analysis for physicians, nurses, chiropractors, dentists, physical therapists and other health professionals on issues impacting their practices.

Physician Law Blog
September 20, 2015

Recent Decision Concerning “Identification” Of Provider Overpayments And The False Claims Act

The Affordable Care Act (PPACA) expanded the False Claims Act (FCA) to require providers to report and return any overpayment within 60 days of identification. Just what “identification” means under this rule has been unclear until now. With the SDNY’s recent ruling in Kane v. Healthfirst, Inc., No. 1:11-cv-02325-ER (SDNY Aug. 3, 2015), there is now guidance. The Kane decision, a whistleblower/false claims case, clarifies what constitutes “identification” for purposes of triggering FCA liability related to the 60 day rule to report overpayments.