MLN: 60-Day Overpayment Refund Rule (42 USC 1320a-7k(d))
Reference to the ACA-added requirement that a Medicare or Medicaid overpayment be reported and returned within 60 days of identification, with FCA exposure for retention beyond that window.
Primary source
42 USC 1320a-7k(d) — Office of the Law Revision Counsel →https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320a-7k&num=0&edition=prelim
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
42 USC 1320a-7k(d), added by the ACA, requires that a person who has received an overpayment from Medicare or Medicaid report and return the overpayment within 60 days of identification (or the corresponding cost report date, whichever is later). Retention of an identified overpayment beyond 60 days is a "reverse false claim" under the False Claims Act.
The 2016 Final Rule implemented the standard for Medicare A/B providers. "Identification" occurs when the provider has, or should have through reasonable diligence, determined that they received an overpayment and quantified its amount.
The 60-day clock begins on identification, with a tolling period of up to six months while the provider conducts reasonable diligence to investigate and quantify. The "lookback" period for overpayments is six years.
Operationally, the rule means: an internal audit, a payer recoupment notice, a vendor coding review, or a whistleblower tip that surfaces an overpayment starts a clock. The provider must investigate promptly, quantify, and either refund or self-disclose (CMS Self-Referral Disclosure Protocol for Stark; OIG Self-Disclosure Protocol for AKS/FCA-adjacent matters) within the prescribed window.
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Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.