42 U.S.C. § 1395b-7 : US Code - Section 1395B-7: Explanation of medicare benefits

Search 42 U.S.C. § 1395b-7 : US Code - Section 1395B-7: Explanation of medicare benefits

(a) In general
The Secretary shall furnish to each individual for whom payment
has been made under this subchapter (or would be made without
regard to any deductible) a statement which -
(1) lists the item or service for which payment has been made
and the amount of such payment for each item or service; and
(2) includes a notice of the individual's right to request an
itemized statement (as provided in subsection (b) of this
section).
(b) Request for itemized statement for medicare items and services
(1) In general
An individual may submit a written request to any physician,
provider, supplier, or any other person (including an
organization, agency, or other entity) for an itemized statement
for any item or service provided to such individual by such
person with respect to which payment has been made under this
subchapter.
(2) 30-day period to furnish statement
(A) In general
Not later than 30 days after the date on which a request
under paragraph (1) has been made, a person described in such
paragraph shall furnish an itemized statement describing each
item or service provided to the individual requesting the
itemized statement.
(B) Penalty
Whoever knowingly fails to furnish an itemized statement in
accordance with subparagraph (A) shall be subject to a civil
money penalty of not more than $100 for each such failure. Such
penalty shall be imposed and collected in the same manner as
civil money penalties under subsection (a) of section 1320a-7a
of this title are imposed and collected under that section.
(3) Review of itemized statement
(A) In general
Not later than 90 days after the receipt of an itemized
statement furnished under paragraph (1), an individual may
submit a written request for a review of the itemized statement
to the Secretary.
(B) Specific allegations
A request for a review of the itemized statement shall
identify -
(i) specific items or services that the individual believes
were not provided as claimed, or
(ii) any other billing irregularity (including duplicate
billing).
(4) Findings of Secretary
The Secretary shall, with respect to each written request
submitted under paragraph (3), determine whether the itemized
statement identifies specific items or services that were not
provided as claimed or any other billing irregularity (including
duplicate billing) that has resulted in unnecessary payments
under this subchapter.
(5) Recovery of amounts
The Secretary shall take all appropriate measures to recover
amounts unnecessarily paid under this subchapter with respect to
a statement described in paragraph (4).