[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: 42CFR405.380]



[Page 99-100]

 

                         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. 405.380  Collection of past-due amounts on scholarship and loan 

programs.



    (a) Basis and purpose. This section implements section 1892 of the 

Act, which authorizes the Secretary to deduct from Medicare payments for 

services amounts considered as past-due obligations under the National 

Health Service Corps Scholarship program, the Physician Shortage Area 

Scholarship program, and the Health Education Assistance Loan program.

    (b) Offsetting against Medicare payment. (1) Medicare carriers and 

intermediaries offset against Medicare payments in accordance with the 

signed



[[Page 100]]



repayment agreement between the Public Health Service and individuals 

who have breached their scholarship or loan obligations and who--

    (i) Accept Medicare assignment for services;

    (ii) Are employed by or affiliated with a provider, HMO, or 

Competitive Medical Plan (CMP) that receives Medicare payment for 

services; or

    (iii) Are members of a group practice that receives Medicare payment 

for services.

    (2) For purposes of this section, ``provider'' includes all entities 

eligible to receive Medicare payment in accordance with an agreement 

under section 1866 of the Act.

    (c) Beginning of offset. (1) The Medicare carrier offsets Medicare 

payments beginning six months after it notifies the individual or the 

group practice of the amount to be deducted and the particular 

individual to whom the deductions are attributable.

    (2) The Medicare intermediary offsets payments beginning six months 

after it notifies the provider, HMO, CMP or group practice of the amount 

to be deducted and the particular individuals to whom the deductions are 

attributable. Offset of payments is made in accordance with the terms of 

the repayment agreement. If the individual ceases to be employed by the 

provider, HMO, or CMP, or leaves the group practice, no deduction is 

made.

    (d) Refusal to offset against Medicare payment. If the individual 

refuses to enter into a repayment agreement, or breaches any provision 

of the agreement, or if Medicare payment is insufficient to maintain the 

offset collection according to the agreed upon formula, then--

    (1) The Department, within 30 days if feasible, informs the Attorney 

General; and

    (2) The Department excludes the individual from Medicare until the 

entire past due obligation has been repaid, unless the individual is a 

sole community practitioner or the sole source of essential specialized 

services in a community and the State requests that the individual not 

be excluded.



[57 FR 19092, May 4, 1992]