CMS Pub. 100-04, ch. 30, § 150.5.3

In determining whether the supplier knew, or could reasonably have been expected to

know, that Medicare would not pay because of the prohibition on unsolicited telephone

contacts under §1834(a)(17)(B) of the Act, presume that the supplier knew that Medicare

would not pay on the basis of constructive notice to the supplier through publication of

the prohibition on such contacts through the contractor’s professional relations function,

as well as publicity through trade organizations’ own publications, professional training,

conventions, etc. The supplier would have to submit convincing evidence to the contrary,

showing ignorance of the prohibition on the supplier’s part, to rebut this presumption. A

single denial of a claim for any item furnished by a particular supplier on the basis of the

prohibition on unsolicited telephone contacts shall be held to be actual notice of the

prohibition to that supplier; and that supplier shall be considered, on that basis, to have

had knowledge that payment would be denied for all such future claims, even those for

different items of medical equipment and supplies. That is, after a single denial under

§1834(a)(17)(B) of a claim by a particular supplier, the presumption of that supplier’s

knowledge becomes nonrebuttable.