{"data":{"id":"us/42-cfr-423.360","jurisdiction":"us","citation":"42 CFR 423.360","heading":"Reporting and returning of overpayments.","body":"(a) Definitions. For the purposes of this section the following definitions are applicable:\nApplicable reconciliation means the later of either the annual deadline for submitting—\n(i) PDE data for the annual Part D payment reconciliations referred to in § 423.343(c) and (d); or\n(ii) Direct and indirect remuneration data.\nFunds 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), § 423.336(c)(1), § 423.343, and data provided for purposes of supporting allowable costs as defined in § 423.308 which includes data submitted to CMS regarding direct or indirect remuneration.\nOverpayment 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.\n(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.\n(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).\n(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.\n(1) Reporting. A Part D sponsor must notify CMS of the amount and reason for the overpayment, using the notification process determined by CMS.\n(2) Returning. A Part D sponsor must return identified overpayments in a manner specified by CMS.\n(e) Enforcement. Any overpayment retained by a Part D sponsor is an obligation under 31 U.S.C. 3729(b)(3) if not reported and returned in accordance with paragraph (d) of this section.\n(f) Look-back period. A Part D sponsor must report and return any overpayment identified within the 6 most recent completed payment years.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT","Subpart G—Payments to Part D Plan Sponsors For Qualified Prescription Drug Coverage"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"f5f084bed59f6e7f559106f2ad3af66b93b8ceb35ca7e07ae5603a8333e3fdd4","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-423.352","next":"us/42-cfr-423.401"},"notice":"GroundRules: Original legal text. Not legal advice."}