[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.355]



[Page 91]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

Subpart C_Suspension of Payment, Recovery of Overpayments, and Repayment 

                        of Scholarships and Loans

 

Sec. 405.355  Waiver of adjustment or recovery.



    (a) The provisions of Sec. 405.352 may not be applied and there may 

be no adjustment or recovery of an incorrect payment (i.e., a payment 

made under Sec. 405.350(a) or Sec. 405.350(b)) in any case where such 

incorrect payment has been made with respect to an individual who is 

without fault, or where such adjustment or recovery would be made by 

decreasing payments to which another person who is without fault is 

entitled as provided in section 1870(b) of the Act where such adjustment 

or recovery would defeat the purpose of title II or title XVIII of the 

Act or would be against equity and good conscience. (See 20 CFR 404.509 

and 404.512.)

    (b) Adjustment or recovery of an incorrect payment (or only such 

part of an incorrect payment as may be determined to be inconsistent 

with the purposes of Title XVIII of the Act) against an individual who 

is without fault shall be deemed to be against equity and good 

conscience if the determination that such payment was incorrect was made 

subsequent to the third year following the year in which notice of such 

payment was sent to such individual. (See Sec. Sec. 405.330-405.332 for 

conditions under which payment may be made for items or services 

furnished after October 30, 1972 which are noncovered by reasons of 

Sec. 405.310 (g) and (k).)



[41 FR 1493, Jan. 8, 1976. Redesignated at 42 FR 52826, Sept. 30, 1977]