[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: 42CFR405.373]



[Page 94]

 

                         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. 405.373  Proceeding for offset or recoupment.



    (a) General rule. Except as specified in paragraph (b) of this 

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

offset or recoupment of payments under Sec. 405.371(a)(2) should be put 

into effect, the intermediary or carrier must--

    (1) Notify the provider or supplier of its intention to offset or 

recoup payment, in whole or in part, and the reasons for making the 

offset or recoupment; and

    (2) Give the provider or supplier an opportunity for rebuttal in 

accordance with Sec. 405.374.

    (b) Paragraph (a) of this section does not apply if the 

intermediary, after furnishing a provider a written notice of the amount 

of program reimbursement in accordance with Sec. 405.1803, recoups 

payment under paragraph (c) of Sec. 405.1803. (For provider rights in 

this circumstance, see Sec. Sec. 405.1809, 405.1811, 405.1815, 

405.1835, and 405.1843.)

    (c) Actions following receipt of rebuttal statement. If a provider 

or supplier submits, in accordance with Sec. 405.374, a statement as to 

why an offset or recoupment should not be put into effect on the date 

specified in the notice, the intermediary or carrier must comply with 

the time limits and notification requirements of Sec. 405.375.

    (d) No rebuttal statement received. If, by the end of the time 

period specified in the notice, no statement has been received, the 

recoupment or offset goes into effect automatically.

    (e) Duration of recoupment or offset. If a recoupment or offset is 

put into effect, it remains in effect until the earliest of the 

following:

    (1) The overpayment and any assessed interest are liquidated.

    (2) The intermediary or carrier obtains a satisfactory agreement 

from the provider or supplier for liquidation of the overpayment.

    (3) The intermediary or carrier, on the basis of subsequently 

acquired evidence or otherwise, determines that there is no overpayment.



[61 FR 63747, Dec. 2, 1996]