Time Limits and Penalties for Healthcare providers and

50.15.3 - Time Limits and Penalties for Healthcare providers and Suppliers in Making Refunds (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) A required refund must be made within specified time limits: • The refund must be made to the beneficiary within 30 days after the date the healthcare provider or supplier receives the remittance advice (RA) if the healthcare provider or/supplier does not request review of an initial full or partial denial; or • The refund must be made to the beneficiary within 15 days after the date the healthcare provider or supplier receives the notice of the review determination if the healthcare provider or supplier requests review within 30 days of receipt of the notice of the initial determination. Healthcare provider or suppliers who knowingly and willfully fail to make a refund where required within these time limits may be subject to civil money penalties and/or exclusion from the Medicare program. The beneficiary should contact the contractor or CMS when a healthcare provider or supplier fails to make a timely refund. If the contractor determines that a healthcare provider or supplier failed to make a refund, it will contact the healthcare provider or supplier in person or by telephone to discuss the facts of the case. The contractor will attempt to determine why the required refund has not been made and will explain the legal requirements. The contractor will determine whether referral to the Office of Inspector General (OIG) or CMS is appropriate and will make appropriate referrals OIG if necessary. The OIG or CMS may impose civil money penalties, assessments, and sanctions if he or she fails to make the required refund. The contractor will retain a detailed written report of contact.