Enrollment Denials When Overpayment Exists

Medicare contractors may deny a Form CMS-855 enrollment application if the current owner of the enrolling provider or supplier or the enrolling physician or non-physician practitioner has an existing or delinquent overpayment that has not been repaid in full at the time an application for new enrollment or Change of Ownership (CHOW) is filed.

An enrollment application may be denied if:

(1) the current owner ( Owner means any individual or entity that has any partnership interest in, or that has 5 percent or more direct or indirect ownership of the provider or supplier of the applying provider or supplier, or

(2) the applying physician or non-physician practitioner, has an existing overpayment that has not been repaid in full at the time the application was filed.

The amount is a debt owed by the debtor to the US Government or US Treasury. Contractors shall generate a daily listing that identifies all organizations, physicians and/or non-physician practitioners with an existing or delinquent overpayment equal to or greater than a threshold of $1500.