Medicaid program; offset based on third party liability recoveries against reductions in Medicaid payments--Health Care Financing Administration. Notice of proposed rulemaking.
Section 2161 of the Omnibus Budget Reconciliation Act (Pub L. (7-35) imposes reductions in Federal matching payments for fiscal years 1982 through 1984, but also provides for offsets against the reductions if a State meets certain conditions. One of the conditions in a specific level of fraud and abuse recoveries by a State or, for fiscal year 1981 only, a combination of fraud and abuse and third party liability recoveries. Interim final rules, published elsewhere in this issue of the Federal Register, amend Medicaid regulations to implement section 2161, except for the provisions relating to third party liability recoveries. We are proposing here that, for purposes of implementing these provisions, recoveries from Medicare would be- . Excluded in situations in which the State had knowledge of the dual entitlement of individuals to Medicare and Medicaid before a Medicaid claim was paid; and . Included in situations in which the State had to make a special effort to determine that an individual's claim should be paid by Medicare.
D003415:Crime; D005607:Fraud; D006296:Health Services / Q000331:legislation & jurisprudence*; D006300:Health Services Misuse / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D014481:United States