US · guidance
CMS Pub. 100-06, ch. 3, § 90
Provider, Physician, or Other Supplier Liability
A provider, physician, or other supplier is liable for overpayments it received unless it is found to be
without fault. The contractor, as applicable, makes this determination.
The contractor considers a provider, physician, or other supplier without fault, if it exercised reasonable
care in billing for, and accepting, the payment; i.e.,
• It made full disclosure of all material facts; and
• On the basis of the information available to it, including, but not limited to, the Medicare
instructions and regulations, it had a reasonable basis for assuming that the payment was correct,
or, if it had reason to question the payment; it promptly brought the question to the contractor’s
attention.
Normally, it will be clear from the circumstances whether the provider, physician, or other supplier was
without fault in causing the overpayment. Where it is not clear, the contractor shall develop the issue.
History
(Rev. 275, Issued: 11-18-16, Effective: 02-21-17, Implementation: 02-21-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a62b5ecca9150b7ae56f36ac3fab245264e6df0898d464636008bce5b4c3badf
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