Basis for conditional Medicare payment in no-fault cases.

(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances: (1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim. (2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy. (b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part. [71 FR 9470, Feb. 24, 2006]