Robinson F
Fulbright & Jaworski, Washington, DC, USA.
Healthc Financ Manage. 1997 Apr;51(4):64-7.
Refunding a significant overpayment to the Medicare or Medicaid program can subject a healthcare organization to government scrutiny that can consume the time and energies of key staff members, risk potential litigation by shareholders, and possibly lead to severe sanctions. Delaying a refund, however, may precipitate even more costly consequences, such as triple damages and heavy monetary penalties. The government has stepped up its efforts to detect and punish fraud and abuse; therefore, providers should refund overpayments promptly. Failure to do so may constitute a crime, increase the likelihood of a whistleblower exposing the offense, or result in an increase in the amount of penalties imposed. Healthcare organizations can prevent overpayment abuses from occurring by following recommended procedures for making refunds, addressing underlying billing problems, and ensuring that senior management oversees the entire claims payment process.
向医疗保险或医疗补助计划退还一笔数额巨大的多付款项，可能会使医疗机构受到政府审查，这会耗费关键工作人员的时间和精力，面临股东潜在诉讼风险，并可能导致严厉制裁。然而，延迟退款可能会引发更昂贵的后果，比如三倍赔偿和巨额罚款。政府已加大力度侦查和惩治欺诈与滥用行为；因此，医疗服务提供者应及时退还多付款项。不这样做可能构成犯罪，增加举报人揭露该违法行为的可能性，或导致处罚金额增加。医疗机构可通过遵循推荐的退款程序、解决潜在的计费问题以及确保高级管理层监督整个理赔支付流程，来防止多付款项滥用情况的发生。
