limitation on adjustment or recovery of incorrect payments under the medicare program

limitation on adjustment or recovery of incorrect payments under the medicare programSec. 281. (a) (1) Section 1870(b)(1) of the Social Security Act is amended by— (A) inserting “(A)” after “the Secretary determines”; and (B) inserting at the end of paragraph (1) the following: 86 Stat. 1455 “(B) that such provider of services or other person was without fault with respect to the payment of such excess over the correct amount, or”. (2) Section 1870(b) of such Act is amended by adding at the end the following new sentence: “For purposes of clause (B) of paragraph (1), such provider of services or such other person shall, in the absence of evidence to the contrary, be deemed to be without fault if the Secretary’s determination that more than such correct amount was paid was made subsequent to the third year following the year in which notice was sent to such individual that such amount had been paid; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title.” (b) Section 1870(c) of such Act (as amended by section 261 of this Act) is further amended by— (1) inserting “or title XVIII” after “title II”, and (2) adding at the end the following new sentence: “Adjustment or recovery of an incorrect, payment (or only such part of an incorrect payment as the Secretary determines to be inconsistent with the purposes of this title) against an individual who is without fault shall be deemed to be against equity and good conscience if (A) the incorrect payment was made for expenses incurred for items or services for which payment may not be made under this title by reason of the provisions of paragraph (1) or (9) of section 1862 and (B) if the Secretary’s determination that such payment was incorrect was made subsequent to the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title.” (c) Section 1866(a)(1) of such Act (as amended by section 227(d)(2) of this Act) is further amended by— (1) redesignating subparagraph (B) as subparagraph (C), and (2) inserting after subparagraph (A) the following new subparagraph: “(B) not to charge any individual or any other person for items or services for which such individual is not entitled to have payment made under this title because payment for expenses incurred for such items or services may not be made by reason of the provisions of paragraph (1) or (9), but only if (i) such individual was without fault in incurring such expenses and (ii) the Secretary’s determination that such payment may not be made for such items and services was made after the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title, and” (d) Section 1842(b) (3) (B) (ii) of such Act (as amended by section 211(c) (3) of this Act) is further amended by— (1) inserting “(I)” after “of which”; and (2) inserting after “service” the following: “and (II) the physician or other person furnishing such service agrees not to charge for such service if payment may not be made therefor by reason of the provisions of paragraph (1) of section 1862, and if the individual to whom such service was furnished was without fault in incurring the expenses of such service, and if the 86 Stat. 1456Secretary’s determination that payment (pursuant to such assignment) was incorrect and was made subsequent to the third year following the year in which notice of such payment was sent to such individual; except that the Secretary may reduce such three-year period to not less than one year if he finds such reduction is consistent with the objectives of this title.” (e) Section 1814(a) (1) of such Act is amended to read as follows: “(1) written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the individual to do so, is filed for such payment in such form, in such manner, and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last 3 calendar months of any calendar year to have been furnished in the succeeding calendar year) except that where the Secretary deems that efficient administration so requires, such period may be reduced to not less than 1 calendar year;”. (f) Section 1835(a) (1) of such Act is amended to read as follows: “(1) written request, signed by such individual, except in cases in which the Secretary finds it impracticable for the individual to do so, is filed for such payment in such form, in such manner and by such person or persons as the Secretary may by regulation prescribe, no later than the close of the period of 3 calendar years following the year in which such services are furnished (deeming any services furnished in the last. 3 calendar months of any calendar year to have been furnished in the succeeding calendar year) except that, where the Secretary deems that efficient administration so requires, such period may be reduced to not less than 1 calendar year; and”. (g) The provisions of subsection (a)(1) shall apply with respect to notices of payment sent to individuals after the date of enactment of this Act. The provisions of subsections (a)(2), (b), (c), and (d) shall apply in the case of notices sent to individuals after 1968. The Provisions of subsections (e) and (f) shall apply in the case of services furnished (or deemed to have been furnished) after 1970.