1. 1. 

   Propose full withholding of any benefit payable to the overpaid person in current pay status unless:

   • •

     the debtor or the debtor's authorized representative requests partial withholding at a lesser rate; or

   • •

     withholding of a lesser amount is requested by the referring agency (Centers for Medicare & Medicaid Services (CMS) Central Office, CMS Regional Office or the Medicare contractor).

2. 2. 

   Follow the procedure in SM 00610.790 for establishing the overpayment on ROAR.

   NOTE: Any underpayment should be applied to the overpayment.

3. 3. 

   Complete the Beneficiary Overpayment Return Notice (see HI 02201.015, Exhibit B) and return it to the CMS Central Office, CMS RO or the Medicare contractor upon completion, or cessation of recovery of the overpayment. Include a copy of the SSA overpayment notice. Annotate Medicare contractor or CMS RO's name, address and telephone number to the Special Message field on the MBR.

1. 1. 

   If the overpaid individual is not in current pay status, return the Medicare overpayment file to the referring agency (CMS Central Office, CMS RO or the Medicare contractor) and explain why SSA cannot withhold the overpayment.

2. 2. 

   If the overpaid individual becomes ineligible for payment during the recovery of the overpayment, complete the Beneficiary Overpayment Return Form (see HI 02201.015, Exhibit B), remove the overpayment from the ROAR, then send it to the referring agency (CMS Central Office, CMS RO or the Medicare contractor) within 60 calendar days. Explain why recovery of the overpayment was stopped.

1. 1. 

   If a waiver, compromise or appeal request is pending for an SSA overpayment, return the Medicare overpayment file to the referring agency (CMS Central Office, CMS RO or the Medicare contractor) within 60 calendar days. Explain why the total or the balance of the overpayment recovery request cannot be withheld.

2. 2. 

   If recovery process of the Medicare overpayment has begun when an SSA overpayment is discovered, stop the withholding and remove the Medicare overpayment from ROAR. Complete the Beneficiary Overpayment Return Notice (see HI 02201.015, Exhibit B) and send to the referring agency (CMS Central Office, CMS RO or the Medicare contractor) within 60 calendar days. Explain why the balance of the overpayment recovery request cannot be withheld, include a timeframe when the referring agency (CMS Central Office, CMS RO or the Medicare contractor) can resubmit the title XVIII overpayment to the appropriate SSA office.

   Example: If SSA received an overpayment from CMS on 4/9/01 and there is already an existing SSA overpayment, then the Beneficiary Overpayment Return Notice (HI 02201.015, Exhibit B) would have a date that is SSA's best guess as to when the overpayment can be resubmitted, e.g., 10/9/01 (6 months) or 4/9/02 (1 year).

   NOTE: Any money previously withheld will be applied to the Medicare overpayment and placed in the appropriate Medicare Trust Fund (see HI 02201.015, Exhibit B). Any compromise requests must be forwarded to the appropriate CMS RO.

3. 3. 

   The beneficiary requests waiver because of an adverse change in the beneficiary's financial situation. The waiver request should be forwarded to the referring agency (CMS Central Office, CMS RO or the Medicare contractor) within 60 calendar days from receipt of the waiver request.

4. 4. 

   The beneficiary dies during the overpayment recovery period, propose adjustment against survivor benefits payable on the overpaid earnings record. The Beneficiary Overpayment Return Notice (See HI 02201.015, Exhibit B) should be completed and returned to the appropriate referring agency (CMS Central Office, CMS Region Office or the Medicare contractor) within 60 calendar days upon receipt of the notification of death. Include an explanation on what decision has been made to further recover the overpayment.

The first paragraph reminds the beneficiary about the Medicare overpayment and amount.

The second paragraph contains the cause or circumstance leading to the overpayment.

Example l: "The overpayment is the result of an incorrect Part A payment made to a provider on your behalf. A copy of the Medicare notice is attached." (Not to be used for a Medicare Secondary Payer (MSP) situation.)

Example 2: "The overpayment is the result of an incorrect payment made to you on a Part B claim for services rendered by a physician/practitioner/supplier. A copy of the Medicare notice is attached." (Not to be used for an MSP situation.)

Example 3: "The overpayment is the result of the settlement of a Medicare Secondary Payer Liability case, where Medicare paid your medical bills related to the underlying accident or illness on a conditional basis. At the time of the settlement Medicare was not reimbursed as required by law. A copy of the Medicare notice is attached."

Example 4: "The overpayment is the result of a duplicate primary payment made to you by Medicare AND your insurance company."