US · guidance
CMS Pub. 100-06, ch. 3, § 20.3
Provider is No Longer Participating in Medicare But Is Participating in
Medicaid
(Rev. 29, 01-02-04)
If the FI discovers an overpayment upon the filing of a cost report, or on determination of the amount of
program reimbursement for a former Medicare provider that is still participating in Medicaid, it shall
immediately contact the provider to obtain a refund in a lump sum, if it has not been made.
The first demand letter shall be sent and all subsequent collection activities performed as specified in
§20.1 and Chapter 4, §10-20.
The first demand letter must provide notice (See Chapter 4, §10-20 and §60) that action to withhold its
Federal share of Medicaid payments will be requested if repayment arrangements are not made within
15 days of the date of this notice. The second demand letter must provide notice that action to withhold
its Federal share of Medicaid payments has been requested and will be initiated if repayment
arrangements are not made. The FI shall send the third demand letter 30 days following the second
where the provider has not responded, even though procedures for withholding the Federal share of
payments in title XIX have been initiated, so that if recoupment efforts and withholding of Medicaid
funds are not effective, the case will be ready for referral to the Department of Treasury.
If the terminated provider has sold the entity to a participating provider refer to Chapter 3, §130 for change
of ownership instructions.
History
(Rev. 29, 01-02-04)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
af405ff99562272687413499456eda790a0fa88ccf5fdc8ccc3d4693c0fa07b8
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