42 CFR 411.37 - Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement.
(a)Recovery against the party that received payment -
(i) Procurement costs are incurred because the claim is disputed; and
(ii) Those costs are borne by the party against which CMS seeks to recover.
(b)Recovery against the primary payer. If CMS seeks recovery from the primary payer, in accordance with § 411.24(i), the recovery amount will be no greater than the amount determined under paragraph (c) or (d) or (e) of this section.
(1) Determine the ratio of the procurement costs to the total judgment or settlement payment.
(2) Apply the ratio to the
(3) Subtract the
(e)CMS incurs procurement costs because of opposition to its recovery. If CMS must bring suit against the party that received payment because that party opposes CMS's recovery, the recovery amount is the lower of the following:
(2) The total judgment or settlement amount, minus the party's total procurement cost.
Title 42 published on 16-Nov-2018 03:48
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR Part 411 after this date.