Which Envelope Should You Open First?

A step-by-step guide to the overpayment refund process
If you hold on to an overpayment, you need to know what to expect when CMS comes knocking at your door. Here's a basic outline of how the game is played:

1. CMS discovers the overpayment and sends you a letter of recoupment asking for its money back. "It will say something like 'We looked at this, and you owe us $5,000,' and will give you details for the basis of the refund," says Wayne Miller, Esq., founding partner of Compliance Law Group in Los Angeles. The letter will also include appeal rights.
2. If you don't respond to the first correspondence, Miller says, CMS will send you a second demand.
3. Three strikes, you're out: If you don't respond to the second recoupment demand, the agency will send you a final letter saying, "We are going to withhold this for future payments to you," Miller says. "You have a right to appeal this, which starts as an administrative appeal - a paper appeal before a hearing officer."
4. If you don't like the result of the first appeal, you reserve the right to appeal to federal court if you choose to take it that far. The trick in this case is that you usually have to pony up the refund before going forward with the appeal - but not always, Miller says, so you should check with an attorney.
5. Of course, if you've already paid the refund, you must simply provide proof of the payment.

- Published on 2003-11-06