Provider, Physician, or Other Supplier Liability

90 - Provider, Physician, or Other Supplier Liability (Rev. 12946, Issued:11-08-24; Effective: 12-10-24; Implementation:12-10-24) A provider, physician, or other supplier is liable for overpayments it received unless it is found to be without fault. The Contractor, as applicable, makes this determination. • The Contractor considers a provider, physician, or other supplier without fault, if it exercised reasonable care in billing, and accepting the payment, i.e., it made full disclosure of all material facts; and • Based on the information available, including, but not limited to, the Medicare instructions and regulations, it had a reasonable basis for assuming that the payment was correct, or, if it had reason to question the payment; it promptly brought the question to the Contractor’s attention. Normally, it will be clear from the circumstances whether the provider, physician, or other supplier was without fault in causing the overpayment. Where it is not clear, the Contractor shall develop the issue.