CMS Pub. 100-04, ch. 33, § 10.4

The application of §903(c) to waive (or to reverse) the imposition of a penalty has no

bearing whatsoever on any other Medicare determination that is adverse to the provider

or supplier (such as the denial of a claim in whole or in part). That is, a provider or

supplier’s reliance on erroneous guidance has no bearing on an adverse determination on

a claim, cost, report, etc., and on the application of Medicare’s rules with respect to the

furnishing or non-furnishing of items and services and the submission or non-submission

of claims and other filings.

Further, this section does not supersede, nor take precedence over, any other policy or

process under any other authority delegated to Medicare contractors to waive, forgive,

rescind, or otherwise render inapplicable a penalty when, under such other authority, it is

appropriate and administratively more efficient to do so.

Moreover, a penalty waiver determination made under this section does not have

precedential effect with respect to any consideration as to whether a provider or supplier

was “without fault” under §1870 or §1879 of the Act with respect to the same or related

matter.

Finally, this section does not address the application of §903(c) with respect to any

penalty for which the authority to impose the penalty has been delegated to the Office of

the Inspector General, Department of Health and Human Services (DHHS) or that has

been delegated to CMS but not redelegated to one or more Medicare contractors. To the

extent that the discussion of penalties in §10.3 may be construed as being in conflict with

the foregoing sentence, the instruction contained in the foregoing sentence prevails.

However, CMS may elect to delegate a penalty waiver determination to a Medicare

contractor on an ad hoc basis regarding a penalty that it has the authority to impose.