Individual Overpayments

10.2 - Individual Overpayments (Rev. 12946, Issued:11-08-24; Effective: 12-10-24; Implementation:12-10-24) An individual overpayment is an incorrect payment the Contractor makes to a provider, or a beneficiary for services under title XVIII. Examples of individual overpayment cases are when the Contractor: • Pays the provider, or beneficiary for services rendered after the beneficiary’s benefits have been exhausted, or where the individual was not an eligible beneficiary. • Incorrectly applies the deductible or coinsurance. • Pays for noncovered items and services, including medically unnecessary services or custodial care furnished an individual. • Pays based on a charge that exceeds the reasonable charge. • Processes duplicate charges/claims. • Pays a physician on a non-assigned claim, or pays a beneficiary on an assigned claim, (Payment made to wrong payee). • Makes primary payment/s for items or services for which another entity is the primary payer. • Pays for items or services rendered during a period when the beneficiary was not an eligible Medicare beneficiary.