CMS Pub. 100-06, ch. 3, § 110.7

Where a beneficiary who is liable for an overpayment dies, the contractor shall attempt to recover from

such sources as State welfare agencies, or private insurance plans (see §110.1 of this chapter), or

withhold the overpayment from any underpayments due the beneficiary's estate or due a surviving

relative. (See 42 CFR 424.60)

If the entire overpayment cannot be recovered by the above methods, it shall send a letter (see sample

below) addressed to the estate of the deceased at the address of the legal representative if known, or to

the last known address of the deceased. It shall include the basic information in §110.5 of this chapter

but shall not mention the possibility of installment payments or the possibility of offset against monthly

benefits.

The contractor shall not direct recovery efforts against a person who answered a recovery letter

concerning an overpayment unless it is known that the individual represents the beneficiary's estate. It

shall not recover by offset against underpayments payable to a provider of services or to a person (other

than the beneficiary's estate) who paid the bill.

Model Refund Request to Estate of Deceased Beneficiary (contractor shall adapt to Fit the Situation)

Estate of (deceased beneficiary) (or, if known, "Representative of the Estate of (deceased beneficiary)).

Dear Sir (or Dear M. ___________ if estate representative's name is known).

On (date) we paid (provider's, physician’s, or supplier’s name and location) (deceased beneficiary, if

applicable) $ ________ more than was due for services furnished by (________) on _____ (from

______ through _____)."

(This paragraph should include a clear and complete explanation of how the overpayment

arose, the amount of the overpayment, how it was calculated, and why the payment was not correct.)

The contractor shall add if applicable:

"We have recovered $ __________ from (specify source). Thus, the total remaining overpayment is

$________.

“If other Medicare benefits become payable to the estate and you have not refunded the incorrect

payment, we will withhold the amount owed from those benefits.

If payment was made to the physician, add the following:

Under the Medicare law, the beneficiary is responsible for overpayments made on his behalf if the

(provider, physician) was not at fault in causing the overpayment. In this case ((provider,

physician) name) was not at fault. Therefore, the estate of (deceased beneficiary) is liable for the

$________ incorrectly paid to ((provider, physician) name) for the services it furnished (deceased

beneficiary).

“Please send us a check or money order in the amount of $ ___________ payable to (contractor name)

in the enclosed, self-addressed envelope within 30 days.

NOTE: The contractor shall undertake notification of appeal rights in accordance with the reopening

rules in Medicare Claims Processing, Chapter 29, Appeals of Claims Decisions.

“If you believe that (deceased beneficiary) was without fault in causing this overpayment and that

recovery of the overpayment would be unfair, you may request that recovery of the overpayment be

waived. Your request should include a brief statement of your reasons for requesting waiver."