Posts Tagged ‘Social Security Administration’

CMS: Demand Letters to Medicare Providers & Suppliers Associated with an Item or Service Provided to Incarcerated Beneficiaries

July 17, 2013

The “no legal obligation to pay” exclusion (see section 1862(a)(2) of the Social Security Act and 42 CFR 411.4) generally prohibits Medicare payment under Part A or Part B for individuals who are in custody of penal authorities. Individuals who are in custody include, but are not limited to, individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, on medical furlough, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention or confined completely or partially in any way under a penal statute or rule.

Before Medicare can make payment for any prisoners’ (or for any patients under a government agency’s custody) medical services, all three of the conditions set out below must be met first: (more…)