GroundRules
5 CFR 890.908: Notification of HHS.
Where this section sits in the code
- 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
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.
Collected 2026-08-27T02:23:53Z. Source file · JSON