US · guidance
CMS Pub. 100-16, ch. mc86c17b, § 300.4
Other Provisions
Any claimant, including an individual who received services and the provider or supplier,
has the right to take legal action against an Employer Group Health Plan (EGHP) or
Large Group Health Plan (LGHP) that fails to pay primary benefits for services covered
by both the EGHP or LGHP, Medicare, and to collect double damages. (See §36.5.)
According to §2000 of the Internal Revenue Code (IRC), an excise tax may be imposed
on any employer or employee organization that contributes to the nonconforming EGHP
or LGHP during a calendar year. The amount of tax is 25 percent of the total amount that
the employer or employee organization contributed to the EGHP or LGHP during that
year. This tax penalty does not apply to Federal and other governmental entities.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ba7508153f8273a5879a0fb279786a940e1182b79400582e21667da814bff93c
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