§ 890.908 Notification of HHS.
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Title 5 CFR: Administrative Personnel › Chapter I: OFFICE OF PERSONNEL MANAGEMENT › Part 890: FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM › Subpart I: Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments › § 890.908: § 890.908 Notification of HHS.
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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]
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