Social Security Act, as amended, Section 1870; 42 CFR 405.350-405.358 and 42 CFR 411.24
HI 02201.001 Medicare Overpayments--General
A. DEFINITION OF MEDICARE OVERPAYMENTS
Medicare overpayments are funds a beneficiary has received in excess of amounts due and payable under the Medicare law and regulations.
NOTE: Once an overpayment determination has been made, the amount determined is a debt owed to the United States Government.
Cross program adjustment is mandatory when the Medicare contractor has not recovered or waived an overpayment.
Overpayments that have not been waived by Medicare contractors are referred to SSA when the contractor cannot recover the overpayment and the amount is $1000.00 or over. If SSA is unable to recover the Medicare overpayment, the case should be returned to the referring agency (Centers for Medicare & Medicaid Services (CMS) Central Office, CMS Regional Office or the Medicare contractor.)
D. PROCESS - MEDICARE CONTRACTOR
When a Medicare overpayment is determined, the contractor sends the required beneficiary notice. This notice includes:
an explanation of the cause and amount of the overpayment;
appeal and waiver rights; and
notification to the beneficiary that the overpayment will be referred to SSA for benefit withholding action if a refund is not received.