True Confessions

Suppose you receive money from the government that was wrongly paid. You are willing to repay it. So that's all there is to it, right? Not quite. The third rung of the ROPE ladder addresses fixing problems, which certainly may involve refunding incorrect reimbursement. However, when the government or a third-party payer becomes involved in these issues, it is important to understand your rights and tactical options.

Home care companies have a variety of legitimate reasons to disclose information about improper payments to the government. First, of course, when you discover unequivocal evidence that an incorrect bill has resulted in an overpayment, no law permits you legally to retain the overpayment. Companies often try to argue that such overpayments are offset by undercharges so there is no net gain. This may be, but any such adjustment should be made only after consultation with the government or other payer.

When a company discovers clear evidence of an incorrectly submitted claim that has not yet been paid, the course of conduct is less clear. Under a strict interpretation of federal rules, a claim known to be incorrect will become “false” if it is not reclaimed by the provider within 60 days of submission. However, home care companies often have a relationship with their DMERCs such that it is easier and less confrontational to repay inappropriately received monies than to flag incorrect claims for reclamation. While it is more “correct” to reclaim the incorrect submissions than to wait to repay inappropriately remitted sums, both approaches make sense.

A second reason some companies may want to disclose alleged overpayments, even when the alleged wrongdoing is unclear, is because such disclosure is “the right thing to do.”

In addition to the ethical component of this decision, a company's decision to disclose payment that is not unequivocally proper sends a clear message to its employees, agents and other personnel: “We are committed to total adherence to the rules.” The company's demonstrated willingness to put its money where it words are on the topic of compliance could be particularly important if employees feel that they are being held to a standard not shared by senior executives.