42 U.S.C. § 1395vv : US Code - Section 1395VV: Withholding payments from certain medicaid providers

Search 42 U.S.C. § 1395vv : US Code - Section 1395VV: Withholding payments from certain medicaid providers

(a) Adjustments by Secretary
The Secretary may adjust, in accordance with this section,
payments under parts A and B to any institution which has in effect
an agreement with the Secretary under section 1395cc of this title,
and any person who has accepted payment on the basis of an
assignment under section 1395u(b)(3)(B)(ii) of this title, where
such institution or person -
(1) has (or previously had) in effect an agreement with a State
agency to furnish medical care and services under a State plan
approved under subchapter XIX of this chapter, and
(2) from which (or from whom) such State agency (A) has been
unable to recover overpayments made under the State plan, or (B)
has been unable to collect the information necessary to enable it
to determine the amount (if any) of the overpayments made to such
institution or person under the State plan.
(b) Implementing regulations; notice, opportunity to be heard, etc.
The Secretary shall by regulation provide procedures for
implementation of this section, which procedures shall -
(1) assure that the authority under this section is exercised
only on behalf of a State agency which demonstrates to the
Secretary's satisfaction that it has provided adequate notice of
a determination or of a need for information, and an opportunity
to appeal such determination or to provide such information,
(2) determine the amount of the payment to which the
institution or person would otherwise be entitled under this
subchapter which shall be treated as a setoff against
overpayments under subchapter XIX of this chapter, and
(3) assure the restoration to the institution or person of
amounts withheld under this section which are ultimately
determined to be in excess of overpayments under subchapter XIX
of this chapter and to which the institution or person would
otherwise be entitled under this subchapter.
(c) Payment to States of amounts recovered
Notwithstanding any other provision of this chapter, from the
trust funds established under sections 1395i and 1395t of this
title, as appropriate, the Secretary shall pay to the appropriate
State agency amounts recovered under this section to offset the
State agency's overpayment under subchapter XIX of this chapter.
Such payments shall be accounted for by the State agency as
recoveries of overpayments under the State plan.