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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
: Suspension and Recoupment of Payment to Providers and Suppliers and Collection and Compromise of Overpayments
405.375 - Time limits for, and notification of, administrative determination after receipt of rebuttal statement.
(a) Submission and disposition of evidence. If the provider or supplier submits a statement, under ? 405.374, as to why a suspension of payment, offset, or recoupment should not be put into effect, or, under ? 405.372(b)(2), why a suspension should be terminated, CMS, the intermediary, or carrier must within 15 days, from the date the statement is received, consider the statement (including any pertinent evidence submitted), together with any other material bearing upon the case, and determine whether the facts justify the suspension, offset, or recoupment or, if already initiated, justify the termination of the suspension, offset, or recoupment. Suspension, offset, or recoupment is not delayed beyond the date stated in the notice in order to review the statement.
(b) Notification of determination. The intermediary or carrier must send written notice of the determination made under paragraph (a) of this section to the provider or supplier. The notice must?
(1) In the case of offset or recoupment, contain rationale for the determination; and
(2) In the case of suspension of payment, contain specific findings on the conditions upon which the suspension is initiated, continued, or removed and an explanatory statement of the determination.
(c) Determination is not appealable. A determination made under paragraph (a) of this section is not an initial determination and is not appealable.
[61 FR 63747, Dec. 2, 1996]
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