42 U.S.C. § 1395vv — Withholding payments from certain medicaid providers

(a) Adjustments by the Secretary The Secretary may adjust payments under parts A and B to either of these entities: • An institution that has an agreement with the Secretary under section 1395cc of this title. • A person who accepted payment based on an assignment under section 1395u(b)(3)(B)(ii) of this title. The Secretary may make the adjustment if the institution or person has, or previously had, an agreement with a State agency to provide medical care and services under a State plan approved under subchapter XIX, and the State agency either: (1) has been unable to recover overpayments made under the State plan from the institution or person; or (2) has been unable to collect the information needed to determine whether overpayments were made and, if so, their amount. This section does not define “overpayment,” “assignment,” or “medical care and services.” (b) Regulations; notice and opportunity to be heard The Secretary must issue regulations establishing procedures to carry out this section. The procedures must do all of the following: (1) They must ensure that the authority in this section is used only for a State agency that satisfies the Secretary that it gave adequate notice of a determination or of a need for information. The agency also must have given an opportunity to appeal the determination or to provide the information. (2) They must determine the amount of the payment that the institution or person otherwise would receive under this subchapter. That amount is treated as a setoff against overpayments under subchapter XIX. (3) They must ensure that amounts withheld under this section are restored to the institution or person if it is ultimately determined that the amounts were more than the overpayments under subchapter XIX and otherwise would have been payable under this subchapter. This section does not define “setoff,” “adequate notice,” or “appeal.” (c) Paying recovered amounts to States Despite any other provision of this chapter, the Secretary must pay the appropriate State agency, from the trust fund established under section 1395i or section 1395t of this title as appropriate, amounts recovered under this section. The payment must offset the State agency’s overpayment under subchapter XIX. The State agency must record these payments as recoveries of overpayments under the State plan. This section does not define “trust fund” or “recoveries of overpayments.”