60-Day Overpayment Rule
ACA requirement that Medicare and Medicaid overpayments be reported and returned within 60 days of identification.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Compliance Program
- Primary sources
- 2
- Workspace handoff
- compliance binder →
Where this comes up
Compliance committees and practice managers operate at this level — written policy, workforce training, sanction policy, monitoring and auditing cadence, response and corrective action. The seven elements of an effective compliance program (OIG) are the scaffolding; this term lives somewhere on that scaffold.
Full definition
What it is in practice
42 CFR 401.305 requires reporting and returning overpayments within 60 days of identification, looking back six years. Failure can create False Claims Act exposure.
How it shows up in your practice
When an audit identifies overpayments, document the identification date and return via the MAC's overpayment process within 60 days. Build the 60-day clock into the audit-finding workflow.
Sources
- 42 CFR §401.305 — 60-Day Overpaymenthttps://www.ecfr.gov/current/title-42/chapter-IV/subchapter-A/part-401/subpart-D/section-401.305
- DOJ — False Claims Acthttps://www.justice.gov/civil/false-claims-act
Track overpayments in the Compliance Binder
Open compliance binder →Related terms
- Compliance ProgramFalse Claims ActFederal statute (31 USC 3729-3733) that imposes liability on persons and companies who defraud federal programs.
- Compliance ProgramOIG Self-DisclosureThe HHS-OIG Self-Disclosure Protocol allowing providers to disclose actual or potential violations of federal fraud and abuse laws.
- Denials & AppealsRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryFalse Claims ActFederal statute (31 USC 3729-3733) that imposes liability on persons and companies who defraud federal programs.
- GlossaryOIG Self-DisclosureThe HHS-OIG Self-Disclosure Protocol allowing providers to disclose actual or potential violations of federal fraud and abuse laws.
- GlossaryRecovery Audit Contractor (RAC)CMS contractors who identify and recover improper Medicare payments through review of paid claims.
- GlossaryWhistleblower (Qui Tam)Under the False Claims Act, a private person who files suit on behalf of the United States alleging fraud and shares in the recovery.
- RegulationFalse Claims Act Overview (31 USC 3729)The principal civil fraud statute for healthcare: prohibits knowingly presenting false claims to the federal government, with treble damages, per-claim penalties, qui tam relator actions, and integration with AKS and Stark.
- BillingWhat to Do When a Payer Says You're UnderbillingGot a letter saying you're underbilling? Here's what it actually means, whether you should worry, and what action to take.
- ComplianceThe Medicare 60-Day Overpayment Rule: How to Comply (and What Triggers Worse)The 60-day clock starts at identification. Miss it, and the overpayment becomes a False Claims Act violation. Here is the actual procedure.
- ComplianceAmbulatory Surgery Center Compliance: CMS + State + Infection Control42 CFR Part 416 Conditions for Coverage, CMS State Operations Manual Appendix L, the ASC Infection Control Surveyor Worksheet, and where state ASC licensure tightens the standard.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.