§411.22. Reimbursement obligations of primary payers and entities that received payment from primary payers.
42 C.F.R. § 411.22
A primary payer, and an entity that receives payment from a primary payer, must reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to make payment.
A primary payer's responsibility for payment may be demonstrated by—
A judgment;
A payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary payer or the primary payer's insured; or
By other means, including but not limited to a settlement, award, or contractual obligation.
The primary payer must make payment to either of the following:
To the entity designated to receive repayments if the demonstration of primary payer responsibilities is other than receipt of a recovery demand letter from CMS or designated contractor.
As directed in a recovery demand letter.
Notes, amendments, and revision history
Amendments
[71 FR 9470, Feb. 24, 2006, as amended at 73 FR 9684, Feb. 22, 2008]
Authority
Authority: 42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn.
Source
Source: 54 FR 41734, Oct. 11, 1989, unless otherwise noted.
Amendments
[71 FR 9470, Feb. 24, 2006, as amended at 73 FR 9684, Feb. 22, 2008]