42 CFR 411.406 - Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as custodial care or as not reasonable and necessary
| Cite as | 42 CFR 411.406 |
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27 practice notes
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Maximum Comfort, Inc. v. Thompson, No. CIV. S-03-1584 LKK/PA.
...to hold a patient's medical information confidential unless the information falls under an enumerated exceptions). 22. According to 42 C.F.R. § 411.406(e)(1), a supplier will be presumed to know that an item was not reasonable and necessary where the supplier has received relevant CMS notic......
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Yale-New Haven Hosp., Inc. v. Thompson, No. 3:99CV2546 (GLG).
...none of the allegations on which it is based is legally relevant to a waiver of financial liability under 42 U.S.C. § 1395pp. See 42 C.F.R. § 411.406(e)(1). Section § 1395pp(a) provides in relevant part that where a determination is made that services furnished to an individual by a provide......
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Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
...financially liable for the costs of the tests. (A.R. at 41.) In support of this further conclusion, the ALJ noted that, pursuant to 42 C.F.R. § 411.406(e), a Medicare provider "may be deemed to have constructive notice of noncoverage based on the receipt of CMS notices, including manua......
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Almy v. Sebelius, Civil Action No. RDB–08–1245.
...entity with knowledge or constructive knowledge of an imminent coverage denial, the supplier must shoulder liability for its costs. 42 C.F.R. § 411.406(e). Suppliers may provide beneficiaries with written “advance beneficiary notice” (“ABN”) that states that Medicare will probably not cover......
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26 cases
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Yale-New Haven Hosp., Inc. v. Thompson, No. 3:99CV2546 (GLG).
...none of the allegations on which it is based is legally relevant to a waiver of financial liability under 42 U.S.C. § 1395pp. See 42 C.F.R. § 411.406(e)(1). Section § 1395pp(a) provides in relevant part that where a determination is made that services furnished to an individual by a provide......
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Willowood of Great Barrington, Inc. v. Sebelius, C.A. No. 08-CV-30076-MAP.
...financially liable for the costs of the tests. (A.R. at 41.) In support of this further conclusion, the ALJ noted that, pursuant to 42 C.F.R. § 411.406(e), a Medicare provider "may be deemed to have constructive notice of noncoverage based on the receipt of CMS notices, including manual iss......
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Almy v. Sebelius, Civil Action No. RDB–08–1245.
...entity with knowledge or constructive knowledge of an imminent coverage denial, the supplier must shoulder liability for its costs. 42 C.F.R. § 411.406(e). Suppliers may provide beneficiaries with written “advance beneficiary notice” (“ABN”) that states that Medicare will probably not cover......
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Anghel v. Sebelius, No. 10–CV–4574 (ADS)(AKT).
...bulletins, or other written guides or directives from intermediaries, or Carriers, or [Quality Improvement Organizations].” See42 C.F.R. § 411.406(e). It is obvious to the Court that Dr. Anghel's addition of physical therapy services to her practice is what instigated the present dispute, a......
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