Medicare_Carriers_Manual / 7116 / 7116

Why This Topic Matters

It helps readers understand when overpayment recovery may be paused and referred for a waiver determination, which can affect beneficiary liability and recovery workflow.

Article Sections

1. 7116. When Carrier Does Not Take Recovery Action in Beneficiary Cases But Refers Cases to HCFA for Waiver of Recovery Consideration

   Overview of referral of certain overpayment cases to HCFA for waiver-of-recovery consideration and the general criteria discussed in the manual section.

2. A. Overpayment to Without Fault Physician

   Discussion of one category of overpayment cases involving physicians and the circumstances under which they are addressed in the manual.

3. B. Overpayments to Beneficiaries for Any Noncovered Services

   Coverage of beneficiary overpayments tied to noncovered services and the manual’s placement of these cases for waiver review.

4. C. Overpayments to Beneficiaries for Other Than Noncovered Services Discovered Subsequent to the Third Calendar Year After the Year of Payment

   Treatment of beneficiary overpayments discovered after a specified time period and the related manual reference cited in the section.

5. D. Overpayments Which Resulted From Misinformation From an Official Source Concerning the Medicare Law or Regulations

   Discussion of overpayments associated with reliance on incorrect information from official Medicare sources and the exception noted in the text.

6. E. Overpayments to Physicians or Beneficiaries for Items and Services Rendered During a Period When SSA Records Showed that the Beneficiary Did Not Have Medicare Entitlement

   Cases involving lack of Medicare entitlement in SSA records and the manual’s handling references for those overpayments.

7. F. Overpayments for Services Which Should Have Been Paid for by Another Insurer or Under Another Government Program

   Cases involving potential payment responsibility by another insurer or government program and the related expiration of claim periods.

8. G. Overpayments for Which a Medicaid Beneficiary Is Liable and Which the Medicaid Agency Does Not Refund

   Discussion of Medicaid-related overpayments and the circumstances noted in the manual when waiver review may not apply.

9. H. Overpayments to Physicians Resulting From Incorrect Reasonable Charge Profiles Where the Beneficiary Is Liable

   Coverage of overpayments tied to incorrect reasonable charge profiles and the note regarding recovery handling when a beneficiary is involved.