There are situations when a beneficiary becomes entitled to Hospital Insurance (HI)
and Supplementary Medical Insurance (SMI) coverage in error that is not due to any
fraud or similar fault on the part of the beneficiary.
This most often occurs because:
we used an incorrect date of birth (DOB),
we established an incorrect date of entitlement to disability benefits (DOED), or
we did not process a SMI refusal request timely.
The cause of the erroneous entitlement can be due to:
we receive subsequent evidence that makes the earlier HI and SMI entitlement dates
erroneous based on the earlier dates.
Currently, we have no authority to grant relief for erroneous entitlement to free
HI coverage. Procedures outlined in this section will result in the deletion of any
period of free HI coverage that is determined to be erroneous on both the Master Beneficiary
Record (MBR) and Enrollment Data Base (EDB) record. If the beneficiary uses HI during
the period now considered erroneous, and the Centers for Medicare & Medicaid Services
(CMS) makes the payment, considering the resulting overpayment for waiver under special
procedures used by CMS.
Once we determine erroneous entitlement to free HI and SMI, the corrective action
depends on whether we discover the error before, during, or after the correct Initial
Enrollment Period (IEP), as established by the new evidence. In all cases, the IEP
referred to is the IEP established due to the changed DOB or newly established Date
of Entitlement to Disability (DOED).