
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1396m]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
    SUBCHAPTER XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
 
Sec. 1396m. Withholding of Federal share of payments for certain 
        medicare providers
        

(a) Adjustment of Federal matching payments

    The Secretary may adjust, in accordance with this section, the 
Federal matching payment to a State with respect to expenditures for 
medical assistance for care or services furnished in any quarter by--
        (1) an institution (A) which has or previously had in effect an 
    agreement with the Secretary under section 1395cc of this title; and 
    (B)(i) from which the Secretary has been unable to recover 
    overpayments made under subchapter XVIII of this chapter, or (ii) 
    from which the Secretary has been unable to collect the information 
    necessary to enable him to determine the amount (if any) of the 
    overpayments made to such institution under subchapter XVIII of this 
    chapter; and
        (2) any person (A) who (i) has previously accepted payment on 
    the basis of an assignment under section 1395u(b)(3)(B)(ii) of this 
    title, and (ii) during the annual period immediately preceding such 
    quarter submitted no claims for payment under subchapter XVIII of 
    this chapter, or submitted claims for payment under subchapter XVIII 
    of this chapter which aggregated less than the amount of 
    overpayments made to him, and (B)(i) from whom the Secretary has 
    been unable to recover overpayments received in violation of the 
    terms of such assignment, or (ii) from whom the Secretary has been 
    unable to collect the information necessary to enable him to 
    determine the amount (if any) of the overpayments made to such 
    person under subchapter XVIII of this chapter.

(b) Reductions in payments to and by States

    The Secretary may (subject to the remaining provisions of this 
section) reduce payment to a State under this subchapter for any quarter 
by an amount equal to the lesser of the Federal matching share of 
payments to any institution or person specified in subsection (a) of 
this section, or the total overpayments to such institution or person 
under subchapter XVIII of this chapter, and may require the State to 
reduce its payment to such institution or person by such amount.

(c) Notice

    The Secretary shall not make any adjustment in the payment to a 
State, nor require any adjustment in the payment to an institution or 
person, pursuant to subsection (b) of this section until after he has 
provided adequate notice (which shall be not less than 60 days) to the 
State agency and the institution or person.

(d) Regulations

    The Secretary shall by regulation provide procedures for 
implementation of this section, which procedures shall (1) determine the 
amount of the Federal payment to which the institution or person would 
otherwise be entitled under this section which shall be treated as a 
setoff against overpayments under subchapter XVIII of this chapter, and 
(2) 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 XVIII of this chapter and to 
which the institution or person would otherwise be entitled under this 
subchapter.

(e) Restoration to trust funds of recovered amounts

    The Secretary shall restore to the trust funds established under 
sections 1395i and 1395t of this title, as appropriate, amounts 
recovered under this section as setoffs against overpayments under 
subchapter XVIII of this chapter.

(f) Liability of States for withheld payments

    Notwithstanding any other provision of this subchapter, an 
institution or person shall not be entitled to recover from any State 
any amount in payment for medical care and services under this 
subchapter which is withheld by the State agency pursuant to an order by 
the Secretary under subsection (b) of this section.

(Aug. 14, 1935, ch. 531, title XIX, Sec. 1914, as added Pub. L. 96-499, 
title IX, Sec. 905(d), Dec. 5, 1980, 94 Stat. 2618.)

                  Section Referred to in Other Sections

    This section is referred to in section 1396b of this title.
