Beneficiary Liability

100 - Beneficiary Liability (Rev. 13183; Issued: 04-24-25; Effective: 05-27-25; Implementation: 05-27-25) A beneficiary is liable for: • Overpayments made to a provider that was without fault except for overpayments for medically unnecessary services or custodial care where the beneficiary, as well as the provider, was without fault. (See Medicare Claims Processing, Chapter 30, Limitation on Liability.) • Situations in which Medicare pays a provider, and a Workers' Compensation (WC) carrier, automobile medical, or no-fault insurer or any liability insurer; or EGHP pays primary benefits to the beneficiary for the same services. (See Medicare Secondary Payer Manual) • Overpayments made to the beneficiary.