C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL › Subpart D—Handling of Incorrect Collections

42 C.F.R. § 489.40

Definition of incorrect collection

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(a) As used in this subpart, “incorrect collections” means any amounts collected from a beneficiary (or someone on his or her behalf) that are not authorized under subpart C of this part.

(b) A payment properly made to a provider by an individual not considered entitled to Medicare benefits will be deemed to be an “incorrect collection” when the individual is found to be retroactively entitled to benefits.

Notes of Decisions
Cited in 2 cases, 2004–2011 · 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 4× “” 42 C.F.R. § 489.40 (b). CMS argues that this regulation, though it refers to payments made by individuals rather than state Medicaid agencies, requires that providers return state Medicaid funds in cases of retroactive dual eligibility.”
Wentz v. Kindred Hospitals East, L.L.C., 333 F. Supp. 2d 1298 (S.D. Fla. 2004). · cites it 2× “” 42 C.F.R. § 489.40 (a). Further, "[a] payment properly made to a provider by an individual not considered entitled to Medicare benefits will be deemed to be an 'incorrect collection' when the individual is found to be retroactively entitled to benefits.”
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