Recovery from a Beneficiary Who Has Received Primary Payment from Both

20.9 – Recovery from a Beneficiary Who Has Received Primary Payment from Both Medicare and a GHP (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 beneficiary, the A/B MACs and DME MACs recover the appropriate amount from the beneficiary based on the provisions of 42 CFR § 411.24(g). The appropriate amount to be recovered is the lesser of the amount that Medicare paid and the amount that the GHP paid as its full primary payment. Interest charges shall not be accessed to the beneficiary for this type of recovery situation. If Medicare paid the provider, physician, or other supplier and the GHP paid the beneficiary, Medicare does not recover from either entity. Likewise, Medicare does not recover from any entity if the GHP paid the provider, physician, or other supplier and Medicare paid the beneficiary. Medicare has recovery rights against providers, physicians, and other suppliers, and beneficiaries only if both Medicare and the GHP paid the same entity.