TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B - MEDICARE PROGRAM

PART 405 - FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

subpart c - SUSPENSION OF PAYMENT, RECOVERY OF OVERPAYMENTS, AND REPAYMENT OF SCHOLARSHIPS AND LOANS

405.373 - Proceeding for offset or recoupment.

  (a) General rule. Except as specified in paragraph (b) of this section, if the intermediary, carrier, or CMS has determined that an offset or recoupment of payments under 405.371(a)(2) should be put into effect, the intermediary or carrier must (1) Notify the provider or supplier of its intention to offset or recoup payment, in whole or in part, and the reasons for making the offset or recoupment; and (2) Give the provider or supplier an opportunity for rebuttal in accordance with 405.374.

  (b) Paragraph (a) of this section does not apply if the intermediary, after furnishing a provider a written notice of the amount of program reimbursement in accordance with 405.1803, recoups payment under paragraph (c) of 405.1803. (For provider rights in this circumstance, see 405.1809, 405.1811, 405.1815, 405.1835, and 405.1843.) (c) Actions following receipt of rebuttal statement. If a provider or supplier submits, in accordance with 405.374, a statement as to why an offset or recoupment should not be put into effect on the date specified in the notice, the intermediary or carrier must comply with the time limits and notification requirements of 405.375.

  (d) No rebuttal statement received. If, by the end of the time period specified in the notice, no statement has been received, the recoupment or offset goes into effect automatically.

  (e) Duration of recoupment or offset. If a recoupment or offset is put into effect, it remains in effect until the earliest of the following: (1) The overpayment and any assessed interest are liquidated.

  (2) The intermediary or carrier obtains a satisfactory agreement from the provider or supplier for liquidation of the overpayment.

  (3) The intermediary or carrier, on the basis of subsequently acquired evidence or otherwise, determines that there is no overpayment.

[61 FR 63747, Dec. 2, 1996]