US · guidance
CMS Pub. 100-04, ch. 33, § 10.1
Policy
A provider or supplier may be subject to one or more penalties with respect to certain acts
or omissions related to the provider or supplier’s participation in the Medicare program.
However, §903(c) of the Medicare Prescription Drug, Improvement and Modernization
Act of 2003 (MMA), which amended §1871(e) of the Social Security Act (the Act),
establishes a basis to waive a penalty in certain circumstances. Specifically, §903(c)
provides that a provider or supplier shall not be subject to any penalty under an authority
of Title XVIII of the Act or under an authority of Title XI of the Act (that relates to Title
XVIII) if the basis for imposing the penalty was an act or omission that resulted from the
provider or supplier following erroneous guidance from the Medicare program.
The statute provides similarly for waiving interest on an overpayment that was caused by
reliance upon erroneous program guidance. However, this section (i.e., §10 and its
subsections) applies to the penalty provision only.
History
(Rev. 739, Issued: 11-01-05, Effective: 07-24-03, Implementation: 01-19-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b33f81518fd2f2f8335ba45712fd6da5a5398bacc00807321e81b496c2b7041f
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