[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: 42CFR405.371]



[Page 92-93]

 

                         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. 405.371  Suspension, offset, and recoupment of Medicare payments 

to providers and suppliers of services.



    (a) General. Medicare payments to providers and suppliers, as 

authorized under this subchapter (excluding payments to beneficiaries), 

may be--

    (1) Suspended, in whole or in part, by CMS, an intermediary, or a 

carrier if CMS, the intermediary, or the carrier possesses reliable 

information that an overpayment or fraud or willful misrepresentation 

exists or that the payments to be made may not be correct, although 

additional evidence may be needed for a determination; or

    (2) Offset or recouped, in whole or in part, by an intermediary or a 

carrier if the intermediary, carrier, or CMS has determined that the 

provider or supplier to whom payments are to be made has been overpaid.

    (b) Steps necessary for suspension of payment, offset, and 

recoupment. Except as provided in paragraph (c) of this section, CMS, 

the intermediary, or carrier suspends payments only after it has 

complied with the procedural requirements set forth at Sec. 405.372. 

The intermediary or carrier offsets or recoups payments only after it 

has complied with the procedural requirements set forth at Sec. 

405.373.

    (c) Suspension of payment in the case of unfiled cost reports. If a 

provider has failed to timely file an acceptable cost report, payment to 

the provider is immediately suspended in whole or in part until a cost 

report is filed and determined by the intermediary to be acceptable. In 

the case of an unfiled cost report, the provisions of Sec. 405.372 do 

not



[[Page 93]]



apply. (See Sec. 405.372(a)(2) concerning failure to furnish other 

information.)



[61 FR 63746, Dec. 2, 1996, as amended at 67 FR 66813, Nov. 1, 2002]