42 CFR 421.200 - Carrier functions
| Cite as | 42 CFR 421.200 |
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48 practice notes
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Garcia v. Sebelius, CV 10-8820 PA (RZx)
...assignment of benefits executed by the beneficiary. 42 U.S.C. § 1395u(b)(3)(B). These carrier functions are prescribed by regulation. 42 C.F.R. § 421.200. 3. Part B resembles "a private medical insurance program that is subsidized in major part by the federal government." Schweiker v. McClu......
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Schwartz v. Medicare, Civ. A. No. 93-1868 (AJL).
..."Fiscal Intermediaries" or "Carriers," which are often private insurance companies. See 42 U.S.C. §§ 1395h, 1395kk(b); 42 C.F.R. §§ 421.100, 421.200; see also Neurological Assocs., 658 F.Supp. at 469; Fox, 656 F.Supp. at 1238. Fiscal Intermediaries process and review claims submitted by hea......
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State of N.Y. v. Lutheran Center for the Aging, Inc., No. CV 96-4056 (ADS).
...whether they are covered by Medicare and if so, the amount of Medicare payment. 42 U.S.C. § 1395h; 42 C.F.R. §§ 421.100(a), 421.103, 421.200(a). The conditions under which payment is granted or denied are not relevant to the Court's A fiscal intermediary's determination regarding Medicare c......
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Power Mobility Coalition v. Leavitt, No. 05 CV 2027 RBW.
...executed by the beneficiary. Id. (citing 42 U.S.C. § 1395u(b)(3)(B)). These carrier functions are prescribed by regulation, i.e., 42 C.F.R. § 421.200. Id. at 4. DMER carriers process claims for DME (including PMDs) payments within designated regions of the As indicated, Part B coverage exte......
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49 cases
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Maximum Comfort, Inc. v. Thompson, No. CIV. S-03-1584 LKK/PA.
...When payment is made erroneously, an "overpayment" is assessed and "recouped" from subsequent payments due to the DME supplier.3 42 C.F.R. § 421.200(a)(2); see also 42 U.S.C. §§ 1395g(a), 1395l(j), 1395gg(b)(1); 42 C.F.R. §§ 405.370, 405.371(a)(1), (2), 405.350. The Act provides for relief ......
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U.S. v. Canova, Docket No. 03-1291(L).
...audits of providers, like the United HealthCare audit of Raytel, to protect against fraud and overpayment, see 42 U.S.C. § 1395u; 42 C.F.R. § 421.200 (providing non-exclusive list of carrier functions, including provider audits); see generally Pani v. Empire Blue Cross Blue Shield, 152 F.3d......
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Pani v. Empire Blue Cross Blue Shield, Docket No. 97-7086
...42 C.F.R. § 405.371(b) (authorizing carriers to suspend payments under circumstances involving fraud or willful misrepresentation); 42 C.F.R. § 421.200 (nonexhaustive list of carrier responsibilities); Bodimetric Health Servs., Inc. v. Aetna Life & Cas., 903 F.2d Page 74 480, 482 n. 3 (7th ......
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Wolcott v. Sebelius, No. 10–10290.
...determine whether services are covered by Medicare, and determine the amount of payment for services furnished, among other duties. 42 C.F.R. § 421.200. TrailBlazer is acting as the Medicare carrier for Wolcott. Medicare has a highly structured appeals process for claims: The Medicare contr......
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