Continuum Settles Reverse False Claims Case

Facing the uncertainty of trial, Continuum has officially settled reverse false claims allegations for $2.95 million. The government had claimed the company failed to comply with the 60-day deadline to repay Medicaid overpayments. In September 2015, a New York federal court denied Continuum’s request to toss out the case without a trial. A software glitch had caused Continuum to submit roughly 450 erroneous claims to Medicaid between 2009 and 2010 resulting in $800,000 worth of overpayments. Continuum paid the money back but not within 60 days and not in one lump sum but rather via 30 installments made over the course of two years.

Continuum is a landmark case because it was the first federal enforcement action against a provider for failing to meet the Affordable Care Act requirement that overpayments be repaid in full within 60 days of identifying the overpayment. And the case was launched before the CMS issued guidance to help providers comply. Although it came too late for Continuum, the CMS finally laid down some guidelines in February 2016. Bottom Line: According to the Final Rule, providers must exercise what Centers for Medicare & Medicaid Services (CMS) calls “reasonable diligence” in identifying, calculating and repaying overpayments.

Editors Note: For a list of six specific things you should do to meet reasonable diligence criteria, see “Avoid False Claims Liability: CMS Clarifies How to Comply with 60-Day Deadline for Returning Overpayments,” GCA, April 7, 2016

[U.S. v. Continuum Health Partners, Inc., 11 Civ. 2325 (ER), USDC (S.D.N.Y.), August 23, 2016].