42 C.F.R. § 411.22
Reimbursement obligations of primary payers and entities that received payment from primary payers
(a) A primary payer, and an entity that receives payment from a primary payer, must reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to make payment.
(b) A primary payer's responsibility for payment may be demonstrated by—
(1) A judgment;
(2) A payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary payer or the primary payer's insured; or
(3) By other means, including but not limited to a settlement, award, or contractual obligation.
(c) The primary payer must make payment to either of the following:
(1) To the entity designated to receive repayments if the demonstration of primary payer responsibilities is other than receipt of a recovery demand letter from CMS or designated contractor.
(2) As directed in a recovery demand letter.
Notes of Decisions
Cited in 28
cases (11 in the last 5 years), 2008–2026 · leading case: United States v. James Stricker, 524 F. App'x 500 (11th Cir. 2013).
United States v. James Stricker, 524 F. App'x 500 (11th Cir. 2013). “The Secretary of Health and Human Services has issued a regulation, 42 C.F.R. § 411.22 (b), which interprets *508 § 1395y(b)(2)(B)(ii) and provides as follows: A primary payer’s responsibility for payment may be demonstrated by— (1) A judgment; (2) A payment conditioned upon the…”
MSPA Claims 1, LLC v. Infinity Auto Ins. Co., 835 F.3d 1351 (11th Cir. 2016). “The implementing regulations specify that a primary payer must reimburse Medicare “for any payment if it is demonstrated that the primary payer has or had a responsibility to make payment.”
Aetna Life Ins. Co. v. Big Y Foods, Inc., 52 F.4th 66 (2d Cir. 2022). “Unlike Paragraph (2)(B)(ii), however, 42 C.F.R. § 411.22 (b) contains no additional language signifying that it applies only to reimbursement of governmental entities.”
Bio-Med. Applications of Tennessee, Inc. v. Cent. States Se. & Sw. Areas Health & Welfare Fund, 656 F.3d 277 (6th Cir. 2011). “Recognizing that Congress intended to limit the impact of this provision to tortfeasors, the Centers for Medicare and Medicaid Services (which administers Medicare) promulgated a regulation that expressly defines "other means" to include a "contractual obligation.”
Zaleppa v. Seiwell, 9 A.3d 632 (Pa. Super. Ct. 2010). “42 C.F.R. § 411.22 (c) (specifying that a primary payer must make payment to either “an entity designed to receive repayments,” such as a plaintiff receiving a judgment in her favor, or “[a]s directed in a recovery demand letter” from Medicare).”
Protocols, LLC v. Leavitt, 549 F.3d 1294 (10th Cir. 2008). “§ 1395y(b)(2)(B)(ii); 42 C.F.R. § 411.22 . If reimbursement is not made, CMS may sue the insurer or the recipient of a workers’ compensation payment, see 42 U.”
Taransky v. Sec'y of the United States Dep't of Health & Human Servs., 760 F.3d 307 (3rd Cir. 2014). “§ 1395y(b)(2)(B)(ii) (emphasis added); see also 42 C.F.R. § 411.22 (b)(2). The Medicare Manual further provides: “Medicare policy requires recovering payments from liability awards or settlements .”
Collins v. Wellcare Healthcare Plans, Inc., 73 F. Supp. 3d 653 (E.D. La. 2014). “See 42 C.F.R. 411.22(b)(2). Moreover, the Medicare Manual states that “Medicare policy requires recovering payments from liability awards or settlements .”
Hope v. Fair Acres Geriatric Ctr., 174 F. Supp. 3d 880 (E.D. Pa. 2016). “§ 1395y(b)(2)(B)(ii); see also 42 C.F.R. § 411.22 (b) (interpreting § 1395y(b)(2)(B)(ii) and describing the ways in which “[a] primary payer’s responsibility for payment may be demonstrat *892 ed”).”
v. Centura Health Corp., 2020 COA 38 (Colo. Ct. App. 2020). “§ 1395y(b)(2)(B)(ii) (2018); 42 C.F.R. § 411.22 (2019). And “promptly” is defined as within 120 days after the earlier of (1) the date a claim is filed with a liability insurer or a hospital lien is filed or (2) the date the patient is discharged from the hospital.”
United States ex rel. Takemoto v. Hartford Fin. Servs. Grp., Inc., 157 F. Supp. 3d 273 (W.D.N.Y. 2016). “§ 1395y(b)(2)(B)(ii); 42 C.F.R. § 411.22 . 45. If the primary plan pays settlement funds to a Medicare beneficiary or other party who has received or will receive conditional payments, that beneficiary or other party must repay Medicare within 60 days of the payment by the…”
Nat'l Comm. to Preserve Soc. Sec. v. Philip Morris USA Inc., 601 F. Supp. 2d 505 (E.D.N.Y 2009). “42 C.F.R. § 411.22 (emphasis added). The furnished examples are, like those listed in the statute but unlike plaintiffs’ desired battery judgment, completed, executable instruments.”
— 42 C.F.R. § 411.22(b)(2) — 1 case
Collins v. Wellcare Healthcare Plans, Inc., 73 F. Supp. 3d 653 (E.D. La. 2014). “See 42 C.F.R. 411.22(b)(2). Moreover, the Medicare Manual states that “Medicare policy requires recovering payments from liability awards or settlements .”
— 42 C.F.R. § 411.22(b)(3) — 1 case
Bronson Healthcare Grp. Inc v. Conifer Ins. Co. (Mich. Ct. App. 2026).
— 42 C.F.R. § 411.22(c) — 1 case
Zaleppa v. Seiwell, 9 A.3d 632 (Pa. Super. Ct. 2010). “42 C.F.R. § 411.22 (c) (specifying that a primary payer must make payment to either “an entity designed to receive repayments,” such as a plaintiff receiving a judgment in her favor, or “[a]s directed in a recovery demand letter” from Medicare).”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.