Judith Waltz Discusses 2025 Medicare Physician Fee Schedule Regulation

Foley & Lardner LLP partner Judith Waltz commented on a new interpretation of Medicare’s 60-day overpayment rule from the final 2025 Medicare Physician Fee Schedule regulation in the Report on Medicare Compliance article, “Final MPFS Rule Changes Dynamics of 60-Day Rule; Telehealth Coverage Is All Over the Map,” published by the Health Care Compliance Association.

“The idea that intent should be considered is new to the overpayment rule,” Waltz highlighted from the 2025 version, which she said reduces the burden on providers.

“Providers won’t be under as much pressure to be proactive,” she explained, noting that when providers find an overpayment, unless they meet the False Claims Act standard for identification, they may not need to look back six years to see if the overpayment continuously occurred. Yet the risk of an FCA lawsuit remains if a provider knowingly “receives or retains” an overpayment.

“When you realize you have been overpaid, you generally have to give it back,” Waltz added.