 |
Code of Federal Regulations (Last Updated: July 5, 2024) |
 |
Title 5 - Administrative Personnel |
|
Chapter I - Office of Personnel Management |
|
SubChapter B - Civil Service Regulations |
|
Part 890 - Federal Employees Health Benefits Program |
|
Subpart I - Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments |
§ 890.908 - Notification of HHS.
-
§ 890.908 Notification of HHS.
An FEHB plan, under the oversight of OPM, will notify the Secretary of HHS, or the Secretary's designee, if the plan finds that:
(a) A hospital knowingly and willfully collects, on a repeated basis, more than the amount determined to be equivalent to the Medicare part A payment under the DRG-based PPS.
(b) A Medicare participating physician or supplier knowingly and willfully collects, on a repeated basis, more than the amount determined to be equivalent to the Medicare part B payment under the Medicare Participating Physician Fee Schedule.
(c) A Medicare nonparticipating physician or supplier knowingly and willfully charges, on a repeated basis, more than the amount determined to be equivalent to the Medicare limiting charge amount.
[60 FR 26668, May 18, 1995]