C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart C—Suspension of Payment, Recovery of Overpayments, and Repayment of Scholarships and Loans

42 C.F.R. § 405.374

Opportunity for rebuttal

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(a) General rule. If prior notice of the suspension of payment, offset, or recoupment is given under § 405.372 or § 405.373, the Medicare contractor must give the provider or supplier an opportunity, before the suspension, offset, or recoupment takes effect, to submit any statement (to include any pertinent information) as to why it should not be put into effect on the date specified in the notice. Except as provided in paragraph (b) of this section, the provider or supplier has at least 15 days following the date of notification to submit the statement.

(b) Exception. The Medicare contractor may for cause—

(1) Impose a shorter period for rebuttal; or

(2) Extend the time within which the statement must be submitted.

[61 FR 63747, Dec. 2, 1996]
Notes of Decisions
Cited in 7 cases (2 in the last 5 years), 1986–2021 · leading case: Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021).
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Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021). “See 42 C.F.R. §§ 405.374 (a), 405.375(a), 424.”
United States v. Consum. Health Servs. of Am., Inc., 108 F.3d 390 (D.C. Cir. 1997). “§§ 3701 , 3711, 3716-18 (1994); 42 C.F.R. § 405.374 . Our decision does not purport to govern the effect of a petition for bankruptcy on a claim by Medicare for reimbursement of prior overpayments when the provider in question does not continue to provide services post-petition.”
Chaves Cnty. Home Health Serv., Inc. v. Louis W. Sullivan, 931 F.2d 914 (D.C. Cir. 1991). “See 42 C.F.R. § 405.374 (j) (“Any action taken by HCFA under this section regarding the compromise of an overpayment claim .”
Evelyn Buckner v. Margaret Heckler, 804 F.2d 258 (4th Cir. 1986). “See 42 C.F.R. § 405.374 (1985). This the Secretary has done through her fiscal intermediary.”
Visiting Nurses Ass'n of Sw. Indiana v. Shalala, 213 F.3d 352 (7th Cir. 2000). “” 42 C.F.R. § 405.374 . When one compares the “waiver” procedures for individuals to that for providers, the differences are evident.”
Angel's Touch Inc. v. Cochran, No. 3:21-cv-08026 (D. Ariz. May 26, 2021). “” 42 C.F.R. § 405.374 (a). Except as otherwise specified, a provider has “at least 15 24 days” following the notification to submit such a statement.”
Acute Care Ambulance Serv., LLC v. Alex M. Azar II, No. 7:20-cv-00217, 2020 WL 7640206 (S.D. Tex. Dec. 3, 2020). “”156 CMS or the contractor must reexamine whether good cause exists to continue the Medicare payment suspension every 180 days, and “[g]ood cause not to continue to suspend payments to an individual or entity against which there are credible allegations of fraud must be deemed…”
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