Suspension of Payment (See Program Integrity Manual)

40.2 – Suspension of Payment (See Program Integrity Manual) (Rev. 29, 01-02-04) Medicare authority to withhold payment in whole or in part for claims otherwise determined to be payable is found in federal regulations at 42 CFR 405.370-377, which provides for the suspension of payments. Suspension may be used when the contractor possesses reliable information that: • Fraud or willful misrepresentation exists; • An overpayment exists but the amount of the overpayment is not yet determined; • The payments to be made may not be correct; or • The provider fails to furnish records and other requested information. (Some examples include cost reports, credit balance reports, and form CMS-91.)