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First Interpretation of ACA’s 60-Day Rule


In a recent decision of first impression interpreting the "60-day rule" of the Affordable Care Act (ACA), the U.S. District Court for the Southern District of N.Y. in U.S. ex rel. Kane v. Continuum Health Partners, Inc. (Aug. 3, 2015), rejected the hospitals' motions to dismiss a FCA/qui tam suit alleging failure to return Medicaid overpayments within 60 days from the date they were "identified." Although the hospitals had argued that the 60 days begin to run only when a specific overpayment was pinpointed conclusively, the court found that approach would create "a perverse incentive to delay learning the amount due" and that the claims were "identified" when the provider was put on notice of the potential overpayment.

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Gail D. Zirkelbach
Partner – Los Angeles
Phone: +1 213.443.5549