C.F.R. » Title 42 » CHAPTER I—PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER M—INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › PART 136—INDIAN HEALTH › Subpart D—Limitation on Charges for Services Furnished by Medicare-Participating Hospitals to Indians

42 C.F.R. § 136.32

Disallowance

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(a) If it is determined that a hospital has submitted inaccurate information for payment, such as admission, discharge or billing data, an I/T/U may as appropriate—

(1) Deny payment (in whole or in part) with respect to any such services, and;

(2) Disallow costs previously paid, including any payments made under any methodology authorized under this subpart. The recovery of payments made in error may be taken by any method authorized by law.

(b) For cost based payments previously issued under this subpart, if it is determined that actual costs fall significantly below the computed rate actually paid, the computed rate may be retrospectively adjusted. The recovery of overpayments made as a result of the adjusted rate may be taken by any method authorized by law.

Notes of Decisions
Cited in 2 cases (1 in the last 5 years), 2020–2022 · leading case: Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan, No. 1:16-cv-10317 (E.D. Mich. Aug. 7, 2020).
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Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan, No. 1:16-cv-10317 (E.D. Mich. Aug. 7, 2020). “42 C.F.R. §136.32 provides: a) If it is determined that a hospital has submitted inaccurate information for payment, such as admission, discharge or billing data, an I/T/U may as appropriate— (1) Deny payment (in whole or in part) with respect to any such services, and; (2)…”
The Grand Traverse Band of Ottawa & Chippewa Indians, & Its Emp. Welfare Plan v. Blue Cross & Blue Shield of Michigan, No. 5:14-cv-11349 (E.D. Mich. Aug. 3, 2022). “Additionally, “[t]he regulation [specifically, in 42 C.F.R. § 136.32 ] also provided a mechanism for Indian organizations to recover from hospitals that did not apply the required MLR rates.”
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