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TO: All Providers
FROM: Maryland Medicare Part A, Fraud Unit
DATE: January 31, 2000
SUBJECT: Reporting Procedures for Unsolicited/Voluntary Refund Checks from Providers/Suppliers

The purpose of this bulletin is to inform you that the Health Care Financing Administration (HCFA) is requiring all Medicare contractors to submit a quarterly report documenting all unsolicited/voluntary refund checks from providers.

All Medicare contractors receive voluntary refunds (i.e. monies received not related to an open accounts receivable). Fiscal intermediaries generally receive voluntary refunds in the form of an adjustment bill, but may receive some voluntary refunds as checks or reported as credit balances. Further guidance on credit balances will be forthcoming.

We have provided an Overpayment Refund Form attached to this bulletin. The completion of the provider section of this form will enable us to credit monies returned timely and accurately.

All providers subject to a Corporate Integrity Agreement (CIA), should report this fact on the refund form so you will be given credit and enable us to report the refund to OIG.

The use of this form is mandatory effective immediately.

Should you have any questions regarding this bulletin, please contact Donna J. Blaschak, Medicare Fraud Coordinator, at (410) 561-4111.

Click here to open the form. Form will appear in a new browser window for printing.