Issuing a Prior Notice versus Issuing a Concurrent Notice

8.3.2.2.1 – Issuing a Prior Notice versus Issuing a Concurrent Notice (Rev. 13762; Issued: 05-27-26; Effective: 06-29-26; Implementation: 06-29-26) UPICs shall inform the provider of the payment suspension action being taken. When prior notice is appropriate, the UPIC shall, in most instances, give at least 15 calendar days’ prior notice before effectuating the payment suspension. Day one begins the calendar day after the notice is mailed. A. If the Medicare Trust Fund would be harmed by giving prior notice: the UPIC shall recommend to CPI not to give prior notice if, in the UPIC’s opinion, any of the following apply: 1. A delay in implementing the payment suspension will cause the overpayment to rise at an accelerated rate (i.e., dumping of claims); 2. There is reason to believe that the provider may flee the MAC’s jurisdiction before the overpayment can be recovered; 3. The MAC or UPIC has first-hand knowledge of a risk that the provider will cease or severely curtail operations or otherwise seriously jeopardize its ability to repay its debts; or 4. A delay may impact law enforcement’s investigation. If CPI approves waiver of the prior notice requirement, the UPIC shall send the provider notice concurrent with implementation of the payment suspension, but no later than 5 calendar days after the payment suspension is imposed. If additional time is needed to release the notice, the UPIC shall confer with CPI for guidance. B. If the reason for the payment suspension recommendation is because the provider failed to furnish requested information, the UPIC shall recommend that CPI waive the prior notice. If CPI concurs to waive the prior notice requirement, the UPIC shall send the provider notice concurrent with implementation of the payment suspension, but no later than 5 calendar days after the payment suspension is imposed. If additional time is needed to release the notice, the UPIC shall confer with CPI for guidance. C. If the payment suspension recommendation is for a fraud suspension, the UPIC shall recommend to CPI that prior notice not be given. If CPI concurs to waive the prior notice requirement, the UPIC shall send the provider notice concurrent with implementation of the payment suspension, but no later than five calendar days after the payment suspension is imposed. If additional time is needed to release the notice, the UPIC shall confer with CPI for guidance.