§1396m Withholding of Federal share of payments for certain medicare providers

Summary

The Secretary of Health and Human Services may reduce the federal share of Medicaid payments to a State for a quarter when a provider has Medicare overpayments or won’t give information needed to find out if it was overpaid. This can apply to institutions with Medicare agreements or to providers who accepted Medicare assignment but either didn’t file enough claims or owe money. The amount taken from the State can be no more than the smaller of the federal share that would go to that provider or the total Medicare overpayments. The Secretary must give at least 60 days’ notice before any reduction. The Secretary must also make rules saying how to count and apply these setoffs and must return any amounts later found to be more than needed. Money recovered this way goes back into the Medicare trust funds. A provider cannot demand those withheld funds from the State if the Secretary ordered the withholding.