Title 42 — The Public Health and WelfareRelease 119-73not60

§1395vv Withholding Payments From Certain Medicaid Providers

Title 42 › Chapter 7— SOCIAL SECURITY › Subchapter XVIII— HEALTH INSURANCE FOR AGED AND DISABLED › Part E— Miscellaneous Provisions › § 1395vv

Last updated Apr 5, 2026|Official source

Summary

The Secretary may reduce Medicare Part A and B payments to a provider or a person who got assigned payments when that provider had a Medicaid agreement with a State and the State can’t recover Medicaid overpayments from them or can’t get the information needed to figure out the overpayment. The Secretary must make rules that require the State to give notice and a chance to appeal, set how much of a Medicare payment can be held to cover the Medicaid overpayment, and return any withheld money later found to be too much. Recovered amounts are paid from the Medicare trust funds to the State and counted as Medicaid overpayment recoveries.

Full Legal Text

Title 42, §1395vv

The Public Health and Welfare — Source: USLM XML via OLRC

(a)The Secretary may adjust, in accordance with this section, payments under parts A and B to any institution which has in effect an agreement with the Secretary under section 1395cc of this title, and any person who has accepted payment on the basis of an assignment under section 1395u(b)(3)(B)(ii) of this title, where such institution or person—

(1)has (or previously had) in effect an agreement with a State agency to furnish medical care and services under a State plan approved under subchapter XIX, and

(2)from which (or from whom) such State agency (A) has been unable to recover overpayments made under the State plan, or (B) has been unable to collect the information necessary to enable it to determine the amount (if any) of the overpayments made to such institution or person under the State plan.

(b)The Secretary shall by regulation provide procedures for implementation of this section, which procedures shall—

(1)assure that the authority under this section is exercised only on behalf of a State agency which demonstrates to the Secretary’s satisfaction that it has provided adequate notice of a determination or of a need for information, and an opportunity to appeal such determination or to provide such information,

(2)determine the amount of the payment to which the institution or person would otherwise be entitled under this subchapter which shall be treated as a setoff against overpayments under subchapter XIX, and

(3)assure the restoration to the institution or person of amounts withheld under this section which are ultimately determined to be in excess of overpayments under subchapter XIX and to which the institution or person would otherwise be entitled under this subchapter.

(c)Notwithstanding any other provision of this chapter, from the trust funds established under section 1395i and 1395t of this title, as appropriate, the Secretary shall pay to the appropriate State agency amounts recovered under this section to offset the State agency’s overpayment under subchapter XIX. Such payments shall be accounted for by the State agency as recoveries of overpayments under the State plan.

Reference

Citations & Metadata

Citation

42 U.S.C. § 1395vv

Title 42 — The Public Health and Welfare

Last Updated

Apr 5, 2026

Release point: 119-73not60