CMS Pub. 100-06, ch. 3, § 110.3

the Initial Demand Letter

(Rev. 13183; Issued: 04-24-25; Effective: 05-27-25; Implementation: 05-27-25)

Efforts to recover from the beneficiary should be suspended if any of the following conditions exist:

A. The Beneficiary Requests Administrative Appeal, or Questions the Overpayment Decision

The contractor shall make no further recovery efforts until it disposes of the appeal request. (See §110.9

of this chapter)

B. The Beneficiary Requests That Recovery be Waived or States Conditions that Might Qualify the

Beneficiary for Waiver of Recovery

The contractor shall refer beneficiary waiver requests over $20,000 to their RO for waiver eligibility.

C. The Beneficiary Is Receiving Welfare Benefits

If the beneficiary is receiving welfare benefits, i.e., cash benefits or Medicaid, the contractor shall

ascertain whether the welfare agency will reimburse Medicare for all, or part of, the overpayment. (See

§110.1 of this chapter.) If the welfare agency does not refund the overpayment in full, the contractor

shall not attempt recovery from the beneficiary, unless it is apparent that the beneficiary knew or should

have known that the payment was incorrect.

NOTE: If a beneficiary requests an appeal or a waiver after the overpayment has been referred to the

SSA for collection from Title II benefits, the SSA processing center will return the overpayment to the

Medicare contractor to review the waiver and/or appeal.