42 C.F.R. § 411.32

Basis for Medicare secondary payments

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(a) Basic rules. (1) Medicare benefits are secondary to benefits payable by a primary payer even if State law or the primary payer states that its benefits are secondary to Medicare benefits or otherwise limits its payments to Medicare beneficiaries.

(2) Except as provided in paragraph (b) of this section, Medicare makes secondary payments, within the limits specified in paragraph (c) of this section and in § 411.33, to supplement the primary payment if that payment is less than the charges for the services and, in the case of services paid on other than a reasonable charge basis, less than the gross amount payable by Medicare under § 411.33(e).

(b) Exception. Medicare does not make a secondary payment if the provider or supplier is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges.

(c) General limitation: Failure to file a proper claim. When a provider or supplier, or a beneficiary who is not physically or mentally incapacitated, receives a reduced primary payment because of failure to file a proper claim, the Medicare secondary payment may not exceed the amount that would have been payable under § 411.33 if the primary payer had paid on the basis of a proper claim.

The provider, supplier, or beneficiary must inform CMS that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed.

Notes of Decisions

Cited in 18 cases (1 in the last 5 years), 1992–2021 · leading case: Larry Dean Speegle v. Harris Methodist Health System and Harris Methodist Fort Worth

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Larry Dean Speegle v. Harris Methodist Health System and Harris Methodist Fort Worth (2009) texapp · cites it 3× “” 42 C.F.R. § 411.32 (a)(1) (2001) (emphasis added).”

United States v. Rhode Island Insurers' Insolvency Fund (1996) ca1 · cites it 2× “§ 1395y(b)(2)(A); see also 42 C.F.R. § 411.32 (a) (“Medicare benefits are secondary to benefits payable by a third party payer even if the State law or the third party payer states that its benefits are secondary to Medicare benefits or otherwise limits its payments to Medicare…”

Health Insurance Ass'n of America, Inc. v. Shalala (1994) cadc · cites it 4× “The statutory authority for 42 CFR § 411.32 (a)(1) must start with paragraph (1) of 42 U.”

Guadalupe Caldera v. Ins Co. of the State of PA (2013) ca5 “” 42 C.F.R. § 411.32 (a)(1) (emphasis added).”

Frazer v. CNA Insurance (2005) alnd “25 imposes a requirement upon insurers to notify CMS when it has been mistakenly compensated for expenses and 42 C.F.R. 411.32 establishes the rules governing Medicare as a secondary payer.”

River City Fraternal Order of Police Lodge 614, Inc. v. Ky. Ret. Sys. (2019) kyed “42 C.F.R. § 411.32 (a)(1) ("Medicare benefits are secondary to benefits payable by a primary payer even if State law or the primary payer states that its benefits are secondary to Medicare benefits or otherwise limits its payments to Medicare beneficiaries.”

Santana v. Deluxe Corp. (1998) mad “”); see also 42 C.F.R. § 411.32 (a)(1) (“Medicare benefits are secondary to benefits payable by a third party payer even if State law or the third party payer states that its benefits are secondary to Medicare benefits or otherwise limits its payments to Medicare beneficiaries.”

Blue Cross and Blue Shield Ass'n v. Sullivan (1992) dcd “As to 42 C.F.R. § 411.32 (a)(1), there was no comparable preceding provision for the working aged, and the comparable preceding provision for end stage renal disease patients stated that Medicare benefits are secondary to employer policies or plans “even though the employer…”

Meek-Horton v. Trover Solutions, Inc. (2013) nysd “§ 1395y(b)(2)(A); accord 42 C.F.R. § 411.32 (a)(1). Should there be remaining expenses after the primary plan has provided payment, Medicare becomes the “secondary payer” and will cover the remaining balance.”

In Re RJF International Corp. for Exoneration From or Limitation of Liability, Civil & Maritime (2004) rid “” 42 C.F.R. § 411.32 (a)(1). IV. Analysis The Petitioner contends that Avery’s eligibility for Medicare terminates its cure obligation.”

Citizens Insurance Co. of America v. United States (2011) uscfc “§ 1395y(b)(2)(A); accord 42 C.F.R. § 411.32 (a)(1) (2006) (“Medicare benefits are secondary to benefits payable by a primary payer even if State law or the primary payer states that its benefits are secondary to Medicare benefits or otherwise limits its payments to Medicare…”

v. Centura (2020) coloctapp “May 24, 1990); see also 42 C.F.R. § 411.32 (a)(1) (2018) (“Medicare benefits are secondary to benefits payable by a primary payer .”

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