Beneficiary Protests

110.9 - Beneficiary Protests (Rev. 13183; Issued: 04-24-25; Effective: 05-27-25; Implementation: 05-27-25) A beneficiary's reply to a notification of overpayment or request for refund may constitute a request for waiver, or request for appeal, i.e., reconsideration, review, contractor fair hearing, or ALJ hearing as applicable, or a request for both waiver and appeal. A. Protests To Treat as Requests Administrative Appeal The contractor shall consider a beneficiary's reply to a request for administrative appeal (Part A reconsideration, Part B review, Part B fair hearing, or ALJ hearing (both A & B), as applicable) if the beneficiary protests the existence of an overpayment, the amount of the overpayment, or if the nature of the protest is unclear. (See B below for which protests the contractor shall consider requests for waiver.) It shall take no further recovery action in such cases until the administrative appeal process is completed. (See Pub. 100-4, Medicare Claims Processing, Chapter 29, Appeals of Claims Decisions.) The contractor shall tell the beneficiary that the request is being considered (or has been forwarded to the Office of Hearings and Appeals, if a hearing request) and that no action is necessary until further notice. If the overpayment case has been referred to SSA, the contractor shall inform SSA of the appeal so that recovery action by SSA may be suspended pending the results of the appeal. If the appeal determination is that the beneficiary is liable for an overpayment, the contractor shall send the beneficiary another request for refund of the overpayment (including all information in §110.5 of this chapter), unless the beneficiary has also requested waiver. In that event, see B below. B. Protests To Treat as Requests for Waiver If an overpaid beneficiary protests on the grounds of hardship, or that recovery would be inequitable, the contractor shall treat the protest as a request for waiver even if it is filed on a form ordinarily used for requesting administrative appeal. Discontinue collection efforts and make a waiver determination if necessary. If the beneficiary offers evidence of financial condition, the contractor shall include it but shall not solicit such evidence. It shall tell the beneficiary that the overpayment case will be forwarded to the Social Security Administration and that no action is necessary until further notice. NOTE: If the beneficiary has also requested appeal, the contractor shall conduct the appeal prior to the waiver determination.