[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: 42CFR405.375]



[Page 95]

 

                         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. 405.375  Time limits for, and notification of, administrative 

determination after receipt of rebuttal statement.



    (a) Submission and disposition of evidence. If the provider or 

supplier submits a statement, under Sec. 405.374, as to why a 

suspension of payment, offset, or recoupment should not be put into 

effect, or, under Sec. 405.372(b)(2), why a suspension should be 

terminated, CMS, the intermediary, or carrier must within 15 days, from 

the date the statement is received, consider the statement (including 

any pertinent evidence submitted), together with any other material 

bearing upon the case, and determine whether the facts justify the 

suspension, offset, or recoupment or, if already initiated, justify the 

termination of the suspension, offset, or recoupment. Suspension, 

offset, or recoupment is not delayed beyond the date stated in the 

notice in order to review the statement.

    (b) Notification of determination. The intermediary or carrier must 

send written notice of the determination made under paragraph (a) of 

this section to the provider or supplier. The notice must--

    (1) In the case of offset or recoupment, contain rationale for the 

determination; and

    (2) In the case of suspension of payment, contain specific findings 

on the conditions upon which the suspension is initiated, continued, or 

removed and an explanatory statement of the determination.

    (c) Determination is not appealable. A determination made under 

paragraph (a) of this section is not an initial determination and is not 

appealable.



[61 FR 63747, Dec. 2, 1996]