TN 1 (03-05)

HI 02201.005 Medicare Overpayment Referrals to SSA

A. PROCEDURE – PC – WHEN OVERPAYMENTS ARE REFERRED TO SSA

Referred Medicare overpayments should only be processed by SSA if the beneficiary is in current pay status and the overpayment is $1000.00 or more unless one of the following occurs:

  • the debtor or his/her representative, whose debt is less than $1000.00, requests that the debt be withheld from his/her title II payment.

  • circumstances require recovery of the debt (the referring agency will provide an explanation when this situation occurs).

NOTE: Medicare contractors do not have access to SSA records. (See HI 02201.010B. for instructions when the beneficiary is not in current pay status.

B. PROCEDURE – INFORMATION IN A MEDICARE OVERPAYMENT FILE

Medicare overpayment referral to SSA must include the following information:

  • Referral Form - this contains the address of the referring agency (Centers for Medicare and Medicare Services) (CMS) Central Office, CMS Regional Office, or the Medicare contractor) and information pertaining to the case (see HI 02201.015, Exhibit A); and

  • Return Notice - for SSA use in recording information on crediting the CMS Trust Fund (see HI 02201.015, Exhibit B); and

  • Waiver Determination (see HI 02201.015, Exhibit C) - if the Medicare contractor or CMS RO determines that the beneficiary was at fault for the overpayment.

C. PROCEDURE – MEDICARE CONTRACTOR FOLLOW-UP FOR CURRENT STATUS OF A MEDICARE OVERPAYMENT

The Medicare Beneficiary Overpayment Referral Follow-Up Notice (see HI 02201.015, Exhibit D) will be sent to the SSA/PSC by the Medicare contractor when there has been no response to the contractor's original referral notice to the appropriate SSA/PSC after one year, and in situations where the beneficiary is no longer in a pay status. The Medicare contractor must include the date that the original referral notice (Exhibit A) was sent or the date that the return notice (Exhibit B) was received from the SSA/PSC. A response should be sent to the Medicare contractor within 60 calendar days from the receipt of the follow-up notice.

NOTE: The contractor's file will contain all overpayment notification letters and correspondence from the beneficiary and/or the beneficiary's representative.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0602201005
HI 02201.005 - Medicare Overpayment Referrals to SSA - 03/10/2005
Batch run: 01/27/2009
Rev:03/10/2005