Debt and Debtor Definitions

70.3 – Debt and Debtor Definitions (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) For GHP-based debt where the demand was issued to the employer/ other plan sponsor, insurer, third party administrator, GHP, or other plan sponsor, the debt includes all of the claims in a demand letter to a debtor for a particular beneficiary even if a single cover letter has been issued to the debtor for multiple beneficiaries’ claims. For DPP recovery demands to a provider, physician, or other supplier, the debt includes all claims in the recovery demand letter regardless of the number of beneficiaries involved. For liability, no-fault, and workers’ compensation, the debt includes all claims in the recovery demand letter, minus Medicare’s pro-rata share of the beneficiary’s procurement costs and attorney costs/fees when the beneficiary is the identified debtor. This pro rata reduction is only applicable to procurement costs incurred by the beneficiary, and only applicable to recovery from the beneficiary. The pro rata reduction for attorney fees and other costs is not applicable to demands issued to applicable plans as the identified debtor. The “Debtor” is an individual to whom or an entity to which the last recovery demand was issued. Where the demand was issued, to an individual in his/her capacity as legal counsel or representative of any type, the debtor is the beneficiary, provider, physician, other supplier, or other individual or entity being represented. Where recovery is being pursued from the attorney or other representative in his/her own right, the debtor is the attorney or other representative. “Identified debtor” is the debtor identified in the most recently issued demand letter. It does not change the fact that other individuals/entities may have legal obligations with respect to the debt, including any other individual or entity that may have previously received a demand letter. Where an individual, such as an attorney, received the last demand letter in his/her capacity as a representative, the individual/entity being represented is the identified debtor. “Jointly and Severally Liable Debtors” is a reference to multiple entities having equal responsibility for repayment of a debt.