GN 02280.915 Sample Guide — Notice To Representative Payee For Beneficiary With Title XVIII Overpayment
Who Is Currently Receiving Benefits For Beneficiary -Adjustment Proposed - No Waiver
(Name of beneficiary) was previously informed that (he/she) has been overpaid $ by the Medicare Program. The Social Security law requires that we recover the overpayment
by withholding the amount from the social security benefits you receive for (him/her) .
We plan to withhold $ each month beginning with the benefit you will receive for (name of beneficiary) in (month/year) . This will reduce (his/her ) payment to $ a month. We will continue withholding from the benefit you receive for (name of beneficiary) each month until (his/her) overpayment has been fully recovered.
Please call, write or visit any social security office if (1) (name of beneficiary) cannot afford the planned reduction of (his/her) benefit and you would like to request that less of (his/her) monthly benefit be withheld; or (2) you would like more of the monthly benefit withheld
so that the overpayment can be paid back sooner; or (3) you would prefer to make full
refund of the overpayment so that no withholding of the monthly benefit is necessary.
Please take this letter with you if you do visit a social security office. Unless
we hear from you within 30 days, we will reduce (his/her) benefit as shown above.