C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 424—CONDITIONS FOR MEDICARE PAYMENT › Subpart C—Claims for Payment

42 C.F.R. § 424.33

Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals

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All claims for services of providers and all claims by suppliers and nonparticipating hospitals must be—

(a) Filed by the provider, supplier, or hospital; and

(b) Signed by the provider, supplier, or hospital unless CMS instructions waive this requirement.

Notes of Decisions
Cited in 7 cases (2 in the last 5 years), 2002–2025 · leading case: Massachusetts v. Sebelius, 638 F.3d 24 (1st Cir. 2011).
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Massachusetts v. Sebelius, 638 F.3d 24 (1st Cir. 2011). · cites it 17× “§ 1395f(a) and 42 C.F.R. § 424.33 only allow “providers” to receive payments from Medicare, and the Commonwealth is, as it admits, not a provider.”
Charlotte-Mecklenburg Hosp. Auth. v. North Carolina Dep't of Health & Human Servs., 685 S.E.2d 562 (N.C. Ct. App. 2009). · cites it 3× “42 C.F.R. § 424.33 (2005). The Secretary has defined “provider” as follows: Provider means a hospital, a [critical access hospital], a skilled nursing facility, a comprehensive outpatient rehabilitation facility, a home health agency, or a hospice that has in effect an agreement…”
Connecticut Dep't of Soc. Servs. v. Leavitt, 428 F.3d 138 (2d Cir. 2005). “Second, Congress amended the governing statute effective October 1, 1999, to forbid coverage “for home health services .”
Massachusetts v. Sebelius, 677 F. Supp. 2d 397 (D. Mass. 2009). · cites it 5× “§ 1395f(a); 42 C.F.R. § 424.33 . Medicaid is not a provider of medical services.”
United States v. O'Donnell, 28 F. App'x 67 (2d Cir. 2002). “indictment was defective insofar as O’Donnell was not a “participating provider” in the Medicare program, and he did not sign, as required under 42 C.F.R. § 424.33 , the Medicare claim forms admitted as evidence against him at trial; (2) the indictment was insufficient to charge…”
Khoury v. Intermountain Health Care Inc. (D. Utah 2022). “42 C.F.R. § 424.33 (b). Hospital billing is different.”
Carlin (S.D.N.Y. 2025). “§§ 1395f(a), 1395y(a)(21); 42 C.F.R. § 424.33 . By contrast, Part B claims may be submitted directly by beneficiaries.”
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