Sample intent to refer letter

Summary 

The Centers for Medicare and Medicaid Services released this sample intent to refer letter that practices may receive from Medicare Administrative Contractors indicating failure to repay overpayment identified by Recovery Audit Contractors.

Preview 

INTENT TO REFER

RE: Notice of Intent to Refer Debt to the Department of Treasury's Debt Collection Center for Cross Servicing and Offset of Federal Payments and Certain Eligible State Payments

Provider Name:
Provider Number: UNKNOWN
Outstanding Balance: $10,020.00

Dear Sir/Madam,

On 11/18/2011, we sent a letter requesting that you refund a Recovery Auditor-identified overpayment subject to 935, Limitation on Recoupment . As of this date, we have not received your payment, a 935 appeal request, or an application for an extended repayment , and insufficient assigned Medicare claims have been submitted for collection of the balance. The outstanding amount due for this overpayment is $10,020.00 which includes a principal amount of $10,020.00 and interest assessed in the amount of $0.00.

Your debt to the Medicare Program is delinquent and, by this letter, we are providing notice that your debt may be referred to the Department of Treasury's Debt Collection Center (DCC) for Cross Servicing and Offset of Federal Payments. Your debt may be referred under provisions of Federal Law, title 31 of the United States Code, Section 3720A and the authority of the Debt Collection Improvement Act of 1996.

The Debt Collection Improvement Act of 1996 (DCIA) requires Federal agencies to refer delinquent debts to the Department of Treasury and/or the Treasury Offset Program. Under the offset program, delinquent Federal debts are collected through offset of other Federal agency payments you may be entitled to, including the offset of your income tax return through the Internal Revenue Service (IRS). The TOP offsets can also be taken from eligible State payments you are entitled to.

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