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Code of Federal Regulations Title 42. Public Health § 42.493.1826 Suspension of part of Medicare payments

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) Application.

(1) CMS may impose this sanction if a laboratory—

(i) Is found to have condition level deficiencies with respect to one or more specialties or subspecialties of tests;  and

(ii) Agrees (in return for not having its Medicare approval cancelled immediately) not to charge Medicare beneficiaries or their private insurance carriers for the services for which Medicare payment is suspended.

(2) CMS suspends Medicare payment for those specialties or subspecialties of tests for which the laboratory is out of compliance with Federal requirements.

(b) Procedures. Before imposing this sanction, CMS provides notice of sanction and opportunity to respond in accordance with § 493.1810.

(c) Duration and effect of sanction. This sanction continues until the laboratory corrects the condition level deficiencies or CMS cancels the laboratory's approval to receive Medicare payment for its services, but in no event longer than 12 months.

(1) If the laboratory corrects all condition level deficiencies, CMS resumes Medicare payment effective for all services furnished on or after the date the deficiencies are corrected.

(2) [Reserved]

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.493.1826 Suspension of part of Medicare payments - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-493-1826/

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