---
kind: "section"
citation: "42 C.F.R. § 423.360"
title: "42"
number: "423.360"
heading: "Reporting and returning of overpayments."
url: "https://uscodex.org/cfr/42/423.360"
---

# §423.360. Reporting and returning of overpayments.

- (a) **Definitions.** For the purposes of this section the following definitions are applicable:

  Applicable reconciliation means the later of either the annual deadline for submitting—

  - (i) PDE data for the annual Part D payment reconciliations referred to in § [423.343(c)](/cfr/42/423.343.md?p=c) and [(d)](/cfr/42/423.343.md?p=d); or
  - (ii) **Direct and indirect remuneration data.** Funds for purposes of this section, means any payment that a Part D sponsor has received that is based on data submitted by the Part D sponsor to CMS for payment purposes, including data submitted under [§ 423.329(b)(3)](/cfr/42/423.329.md?p=b-3), [§ 423.336(c)(1)](/cfr/42/423.336.md?p=c-1), [§ 423.343](/cfr/42/423.343.md), and data provided for purposes of supporting allowable costs as defined in [§ 423.308](/cfr/42/423.308.md) which includes data submitted to CMS regarding direct or indirect remuneration.

    Overpayment means funds that a Part D sponsor has received or retained under title XVIII of the Act to which the Part D sponsor, after applicable reconciliation, is not entitled under such title.

- (b) **General rule.** If a Part D sponsor has identified that it has received an overpayment, the Part D sponsor must report and return that overpayment in the form and manner set forth in this section.
- (c) **Identified overpayment.** The Part D sponsor has identified an overpayment when the Part D sponsor knowingly receives or retains an overpayment. The term “knowingly” has the meaning set forth in [31 U.S.C. 3729(b)(1)(A)](/usc/31/3729.md?p=b-1-A).
- (d) **Reporting and returning of an overpayment.** A Part D sponsor must report and return any overpayment it received no later than 60 days after the date on which it identified it received an overpayment.
  - (1) **Reporting.** A Part D sponsor must notify CMS of the amount and reason for the overpayment, using the notification process determined by CMS.
  - (2) **Returning.** A Part D sponsor must return identified overpayments in a manner specified by CMS.
- (e) **Enforcement.** Any overpayment retained by a Part D sponsor is an obligation under [31 U.S.C. 3729(b)(3)](/usc/31/3729.md?p=b-3) if not reported and returned in accordance with [paragraph (d)](#d) of this section.
- (f) **Look-back period.** A Part D sponsor must report and return any overpayment identified within the 6 most recent completed payment years.

## Notes

### Amendments

[79 FR 29963, May 23, 2014, as amended at 89 FR 98565, Dec. 9, 2024]

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.

### Source

Source: 70 FR 4525, Jan. 28, 2005, unless otherwise noted.

### Amendments

[79 FR 29963, May 23, 2014, as amended at 89 FR 98565, Dec. 9, 2024]