We will attempt to reschedule the appointment twice. After those attempts, include
the following language in the appointment letter when scheduling the final (third)
“We have tried to schedule an appointment with you twice. Each time we rescheduled,
you were not available. It is very important that you keep this appointment. If you
do not keep this appointment, we may suspend your payments until we speak with you.”
If the beneficiary resides in a nursing home, call the nursing home to verify that
the beneficiary is alive before suspending payment. If the nursing home alleges that
the beneficiary is alive, begin representative payee development, if necessary. If
the nursing home alleges that the beneficiary is deceased, see GN 02602.640 for policy to process the report of death.
If the beneficiary or representative payee fails to keep the third appointment, we
must take the following actions:
Send an advance notice to the beneficiary and the representative payee, if any, informing
them of our planned action to suspend benefits. The advance notice must state the:
reason why we plan to suspend benefits,
evidence we used to make the determination, and
beneficiary has 10 calendar days (plus 5 days for mailing) to respond before we suspend
Establish a diary for 15 calendar days. For more information about the required content
of advance notices in title II cases, see GN 03001.015 and NL 00601.030
After 15 calendar days (10 days plus 5 days for mailing) have passed from the date
you mailed the advance notice and you have not received a response, suspend the beneficiary’s
benefits. Place the record into ledger account file (LAF) S9 with a reason for suspension
or termination code (RFST) of whereabouts unknown (WHEREU).
Add the following message to the MBR:
“MNUP interview needed. Payments suspended for failure to keep MNUP interview appointments.
Immediately remove suspense once MNUP interview is conducted.”
After the MBR shows the LAF code as S9, update the LAF code in the “Medicare Non-Utilization
Project (MNUP)” section on the MNUP website to show that you suspended the beneficiary’s benefits.
Send the beneficiary a final notice that complies with the requirements applicable
to notices of initial determination regarding the suspension. For information about
the required contents of the final notice, see GN 03001.015 and 20 CFR 404.904
When you suspend benefits for failure to keep the appointment, immediately refer the
case to the Office of Inspector General (OIG) using form e8551 (Reporting Form for
Programmatic Fraud). Annotate in remarks the date you referred the case to OIG on
the MNUP website.
Provide as much information as available on the e8551. For more information on referring
a potential violation using the e8551, see GN 04124.001.
NOTE: When completing the e8551 form for the MNUP, select program option “Medicare Non-Utilization”
and place the term MNUP in the description.