§1396m Withholding of Federal Share of Payments for Certain Medicare Providers

Summary

The Secretary can reduce the federal Medicaid money a state gets if the federal government cannot get back Medicare overpayments or cannot get the information needed to figure those overpayments. This rule applies to two kinds of payees: institutions that have or had a Medicare provider agreement, and people who accepted assigned Medicare payments but then filed no claims or only small claims in the prior year. It covers cases where the Secretary cannot recover overpayments or cannot collect needed information. The cut to the state’s federal share for a quarter is limited to the smaller of the federal share of payments to that provider/person or the total overpayments. The Secretary can also require the state to reduce what it pays the provider by the same amount. The Secretary must give at least 60 days’ notice. The Secretary must make rules to decide offsets and must return any withheld money that turns out to be more than the overpayment. Recovered amounts go back to the Medicare trust funds under sections 1395i and 1395t. A provider cannot recover from a state amounts the state withholds under the Secretary’s order.