Recovery from the Provider, Physician, or Other Supplier

20.8 – Recovery from the Provider, Physician, or Other Supplier (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) If both Medicare and the GHP made primary payment to the provider, physician, or other supplier, the A/B MACs and DME MACs shall recover from the provider, physician, or other supplier pursuant to 42 CFR § 411.24(g). Interest charges shall be assessed if repayment of the debt does not occur within the identified timeframe. When a provider, physician, or other supplier receives payment from a GHP where Medicare has also paid, the provider, physician, or other supplier submits an adjustment bill showing the primary payment amount. The fact that the provider, physician, or other supplier received two primary payments establishes the repayment obligation. The A/B MACs and DME MACs shall instruct the provider, physician, or other supplier to return to the beneficiary the amounts of the Medicare deductible and coinsurance already paid. The provider, physician, or other supplier may retain any excess GHP payment over the gross amount payable by Medicare. If duplicate payment was or will be made to the provider, physician, or other supplier, i.e., the provider, physician, or other supplier received both primary GHP payments and primary Medicare benefits, the A/B MACs and DME MACs shall collect the duplicate primary payment from the provider, physician, or other supplier. The amount to be recovered is the lesser of the amount paid by Medicare and the amount that the GHP paid as its full primary payment. If the GHP paid the provider, physician or other supplier on a capitation basis, the appropriate amount to recover is the amount that Medicare paid.