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U.S. Code as of:
01/19/04
Section 1396m. Withholding of Federal share of payments for certain medicare providers
(a) Adjustment of Federal matching payments
The Secretary may adjust, in accordance with this section, the
Federal matching payment to a State with respect to expenditures
for medical assistance for care or services furnished in any
quarter by -
(1) an institution (A) which has or previously had in effect an
agreement with the Secretary under section 1395cc of this title;
and (B)(i) from which the Secretary has been unable to recover
overpayments made under subchapter XVIII of this chapter, or (ii)
from which the Secretary has been unable to collect the
information necessary to enable him to determine the amount (if
any) of the overpayments made to such institution under
subchapter XVIII of this chapter; and
(2) any person (A) who (i) has previously accepted payment on
the basis of an assignment under section 1395u(b)(3)(B)(ii) of
this title, and (ii) during the annual period immediately
preceding such quarter submitted no claims for payment under
subchapter XVIII of this chapter, or submitted claims for payment
under subchapter XVIII of this chapter which aggregated less than
the amount of overpayments made to him, and (B)(i) from whom the
Secretary has been unable to recover overpayments received in
violation of the terms of such assignment, or (ii) from whom the
Secretary has been unable to collect the information necessary to
enable him to determine the amount (if any) of the overpayments
made to such person under subchapter XVIII of this chapter.
(b) Reductions in payments to and by States
The Secretary may (subject to the remaining provisions of this
section) reduce payment to a State under this subchapter for any
quarter by an amount equal to the lesser of the Federal matching
share of payments to any institution or person specified in
subsection (a) of this section, or the total overpayments to such
institution or person under subchapter XVIII of this chapter, and
may require the State to reduce its payment to such institution or
person by such amount.
(c) Notice
The Secretary shall not make any adjustment in the payment to a
State, nor require any adjustment in the payment to an institution
or person, pursuant to subsection (b) of this section until after
he has provided adequate notice (which shall be not less than 60
days) to the State agency and the institution or person.
(d) Regulations
The Secretary shall by regulation provide procedures for
implementation of this section, which procedures shall (1)
determine the amount of the Federal payment to which the
institution or person would otherwise be entitled under this
section which shall be treated as a setoff against overpayments
under subchapter XVIII of this chapter, and (2) assure the
restoration to the institution or person of amounts withheld under
this section which are ultimately determined to be in excess of
overpayments under subchapter XVIII of this chapter and to which
the institution or person would otherwise be entitled under this
subchapter.
(e) Restoration to trust funds of recovered amounts
The Secretary shall restore to the trust funds established under
sections 1395i and 1395t of this title, as appropriate, amounts
recovered under this section as setoffs against overpayments under
subchapter XVIII of this chapter.
(f) Liability of States for withheld payments
Notwithstanding any other provision of this subchapter, an
institution or person shall not be entitled to recover from any
State any amount in payment for medical care and services under
this subchapter which is withheld by the State agency pursuant to
an order by the Secretary under subsection (b) of this section.
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