Current through Register Vol. 54, No. 44, November 2, 2024
(a) For
overpayments relating to cost reporting periods ending prior to October 1,
1985, which were not appealed prior to February 6, 1988, the Department will
use its current policy specified in §§
1101.84(b)(4) and
(5) and
1181.101(f)
(relating to provider right of appeal; and facility's right to a
hearing).
(b) For overpayments
relating to cost reporting periods ending on or after October 1, 1985, the
Department will use the following recoupment procedure:
(1) If an analysis of the provider's audit
report and the Department's payment records, by the Office of the Comptroller,
discloses that an overpayment has been made, or if the provider notifies the
Department in writing that an overpayment has occurred, the Office of the
Comptroller will issue a letter to the provider notifying the provider of the
amount of the overpayment. The letter will request that the provider contact
the Office of the Comptroller within 15 days of the date of the letter to
establish a repayment schedule. The provider's invoices (MA 309C) will continue
to be processed by the Department. The date of the cost settlement letter will
serve as day one in determining relevant time frames.
(2) If the provider does not submit an
acceptable repayment plan to the Department or fails to respond to the cost
settlement letter within the specified time period, the Department will offset
the overpayment amount against the provider's pending MA payments until the
overpayment is satisfied.
(3) An
acceptable repayment schedule includes either direct payment to the Department
by check from the provider or a request by the provider to have the overpayment
offset against the provider's pending claims until the overpayment is
satisfied. To be acceptable, a direct repayment plan or an intermittent offset
plan must ensure the total overpayment amount will be repaid to the Department
no later than the date the Department must credit the Federal government with
the Federal share of the overpayment. Under current Federal procedure, the
overpayment would be due at the end of the calendar quarter during which the
60th day from the date of the cost settlement letter falls.
(4) The Department reserves the right to
refuse to allow a direct repayment plan if a provider chose this method, but
failed to remit payment as agreed for a previous overpayment. When the provider
fails to remit payment, the Department will offset the overpayment against the
provider's MA payments until the overpayment is satisfied.
(5) The procedures in this subsection do not
apply if the provider is bankrupt or out-of-business under section
1903(d)(2)(D) of the Social Security Act (42 U.S.C.A. §
1396b(d)(2)(D)).
(6) An appeal by the provider of the
Department's action to offset the overpayment against the provider's MA
payments when the provider fails either to respond timely to the cost
settlement letter or to pay the overpayment directly when due will not stay the
Department's action.
(7) An appeal
by the provider of the audit disallowance does not suspend the provider's
obligation to repay the amount of the overpayment to the Department. If the
provider prevails in whole or in part in the appeal and is thereby owned money
by the Department, the Department will refund money due the provider as a
result of the provider's appeal.
(c) For overpayments relating to cost
reporting periods prior to October 1, 1985, which were appealed prior to
February 6, 1988, the Department will apply §
1181.101(f) as
effective prior to February 6, 1988, permitting stays of repayment pending the
decision of the Office of Hearings and Appeals on the appeal of the underlying
audit or overpayment, or both.
