On August 3, 2015, the Southern District of New York issued the first judicial opinion in a False Claims Act case brought under CMS’ “60-day rule,” Kane v. Healthfirst, Inc., et al. The court denied the defendant hospitals’ motion to dismiss, finding that the government stated a claim under the False Claims Act (“FCA”) even though the hospitals had repaid the overpayments at issue. The decision is a victory for the government, which took a hardline position based on the 60-day rule that the hospitals’ retention of the overpayments for up to two years violated the FCA. To health care providers and their counsel, this case is instructive of the government’s increased enforcement power under the FCA to go after providers who “put their head in the sand” and fail to fully investigate and correct payment mistakes in a timely manner.
Learn More: First Case Interpreting 60-Day Rule Sides with Government on Meaning of “Identified” Overpayments