What Is an Overpayment?
Overpayments are Medicare payments to a provider/supplier in excess of amounts due and payable under the statute and regulations. Once a determination of an overpayment has been made, the amount is considered a debt owed by the debtor to the United States Government and CGS must attempt recovery of the overpayment in accordance with the Centers for Medicare & Medicaid Services (CMS) regulations. CMS requires CGS to request refunds on non-MSP overpayments of $25 or more. If a supplier owes several small overpayments, each of which is less than $25, the total of the overpayments will be added together and a demand letter will be issued. The $25 tolerance does not apply to MSP overpayments. If a lump sum refund would cause a severe financial hardship, repayment may be accepted over an extended period of time. We have provided additional information on the Extended Repayment Schedule (ERS)
in this section.
The purpose of Overpayment Recovery is to recover money overpaid in error to a Medicare beneficiary or supplier. The funds can be recovered voluntarily from the beneficiary or supplier through a voluntary payment or through a demand letter.
There are two types of voluntary refunds:
- Non-MSP – where Medicare fee-for-service iis primary, and
- MSP – where Medicare fee-for-service is secondary
- If you are unsure if Medicare should have paid as primary or secondary, please review the information available in the MSP section of this website.
If you disagree with the overpayment you may file an appeal.
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