42 CFR §411.402
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (a)Conditions for indemnification. If Medicare payment is precluded because the conditions of § 411.400(a)(2) are not met. Medicare indemnifies the beneficiary (and recovers from the provider, practitioner, or supplier), if the following conditions are met:
- (1)The beneficiary paid the provider, practitioner, or supplier some or all of the charges for the excluded services.
- (2)The beneficiary did not know and could not reasonably have been expected to know that the services were not covered.
- (3)The provider, practitioner, or supplier knew, or could reasonably have been expected to know that the services were not covered.
- (4)The beneficiary files a proper request for indemnification before the end of the sixth month after whichever of the following is later:
- (b)Amount of indemnification. 1 The amount of indemnification is the total that the beneficiary paid the provider, practitioner, or supplier.
- (c)Effect of indemnification. The amount of indemnification is considered an overpayment to the provider, practitioner, or supplier, and as such is recoverable under this part or in accordance with other applicable provisions of law.