OIG Investigation Procedures / Administrative, Civil and Criminal Sanctions / Administrative Sanctions for Health Care Providers / Withdrawal of Favorable Waiver Presumption

Article Overview

This article covers Medicare administrative sanction policy for health care providers, focusing on the favorable waiver presumption and when CMS or an intermediary may withdraw it. It is relevant to compliance staff, billing teams, and providers who handle coverage determinations for Medicare services, including discussion of how liability is addressed when services are later found not covered and how claims may be reviewed after withdrawal. The article provides policy context on provider knowledge, beneficiary protection, and intermediary review without serving as a coding reference.