CMS Pub. 100-01, ch. 2, § 40.8

Administrative Error

(Rev. 1, 09-11-02)

CMS and SSA are authorized to take necessary action to correct an erroneous SMI or

premium hospital insurance enrollment or nonenrollment which was based upon the

action, inaction, or error of a Government officer, employee, or agent. The action may

include designating special individual enrollment periods and premium adjustments.

For the purpose of this provision, an individual's enrollment or nonenrollment in SMI is

considered to have been prejudiced and due to the "action, inaction, or error" of an

officer, employee, or agent of the Government, if there is an official record or other

evidence showing that:

• The individual took reasonable appropriate and timely measures to assert his or

her rights, and

• Due to administrative fault or other action, which may or may not have been

erroneous at the time taken, his or her rights have been or are likely to be

impaired unless relief is given.

This authority applies to all Part B cases which have arisen since the Medicare program

began on July 1, 1966. It is applied to cases that come to CMS's or SSA's attention;

however, MACs should not search their files.