42 C.F.R. § 433.312

Basic requirements for refunds

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) Basic rules. (1) Except as provided in paragraph (b) of this section, the State Medicaid agency has 1 year from the date of discovery of an overpayment to a provider to recover or seek to recover the overpayment before the Federal share must be refunded to CMS.

(2) The State Medicaid agency must refund the Federal share of overpayments at the end of the 1-year period following discovery in accordance with the requirements of this subpart, whether or not the State has recovered the overpayment from the provider.

(b) Exception. The agency is not required to refund the Federal share of an overpayment made to a provider when the State is unable to recover the overpayment amount because the provider has been determined bankrupt or out of business in accordance with § 433.318.

(c) Applicability. (1) The requirements of this subpart apply to overpayments made to Medicaid providers that occur and are discovered in any quarter that begins on or after October 1, 1985.

(2) The date upon which an overpayment occurs is the date upon which a State, using its normal method of reimbursement for a particular class of provider (e.g., check, interfund transfer), makes the payment involving unallowable costs to a provider.

[54 FR 5460, Feb. 3, 1989, as amended at 77 FR 31511, May 29, 2012]

Notes of Decisions

Cited in 12 cases, 1996–2018 · leading case: Texas Child.'s Hosp. v. Burwell, 76 F. Supp. 3d 224 (D.D.C. 2014).

Sort: Relevance Newest Treatment

Texas Child.'s Hosp. v. Burwell, 76 F. Supp. 3d 224 (D.D.C. 2014). · cites it 2× “Indeed, the Texas Health and Human Services Commission has already informed Texas Children’s that it “ ‘will recoup any overpayment of DSH funds’ that is identified in the state’s final 2011 audit report to CMS.”

Tenn. Hosp. Ass'n v. Alex M. Azar, II, 908 F.3d 1029 (6th Cir. 2018). “at 77 ,906 ; 42 C.F.R. § 433.312 . According to letters from CMS notifying plaintiffs of the audit results, Takoma Adventist Hospital owed $188,987, R.”

N.H. Hosp. Ass'n v. Azar, 887 F.3d 62 (1st Cir. 2018). “See 42 C.F.R. § 433.312 . Plaintiffs first petitioned CMS to withdraw the FAQs.”

Finnerty v. Thornton Hall, Inc., 593 S.E.2d 568 (Va. Ct. App. 2004). “” 42 C.F.R. § 433.312 (a)(2) (emphasis added).”

LifeCare Med. Transports, Inc. v. Virginia Dep't of Med. Assistance Servs., 759 S.E.2d 35 (Va. Ct. App. 2014). “”). Federal law has defined an overpayment as “the amount paid by a Medicaid agency to a provider which is in excess of the amount that is allowable for services furnished.”

Alameda Health Sys. v. Ctrs. for Medicare & Medicaid Servs., 287 F. Supp. 3d 896 (N.D. Cal. 2017). “; see 42 C.F.R. § 433.312 (a). California's State Plan also includes a redistribution provision.”

Georgia Dep't of Cmty. Health v. United States Dep't of Health & Human Servs., 79 F. Supp. 3d 269 (D.D.C. 2015). “See 42 C.F.R. 433.312. The return of an overpayment is effectuated by listing the credit in the QSE (line 10.”

In re Dist. Mem'l Hosp. of, Sw. North Carolina, Inc., 297 B.R. 451 (Bankr. W.D.N.C. 2002). “42 C.F.R. §§ 433.312 (b); 433.318 (2002).”

In Re Dist. Mem. Hosp. Of, Sw. Nc, 297 B.R. 451 (Bankr. W.D.N.C. 2002). “42 C.F.R. §§ 433.312 (b); 433.318 (2002).”

NH Hosp. Ass'n v. Hargan (1st Cir. 2018). “See 42 C.F.R. § 433.312 . Plaintiffs first petitioned CMS to withdraw the FAQs.”

NH Hosp. Assoc. v. US Dep't HHS, 2016 DNH 053 (D.N.H. 2016). “23 22State agencies must recoup alleged overpayments within one year of discovering them, 42 C.F.R. § 433.312 (a), or the federal government will recoup its share.”

Care Providers of Minnesota, Inc. v. Gomez, 545 N.W.2d 45 (Minn. Ct. App. 1996). “42 C.F.R. § 433.312 (a) (1993) (emphasis added).”

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.