This section provides information about the following topics regarding overpayments:
At Reconciliation, an overpayment may exist on an application for the following reasons: the sum of previous payment request(s) exceeds the current subsidy amount based on the most recent Allowable Retiree Costs and/or the Mandatory Payment Reduction.
In addition, if a Plan Sponsor fails to meet the Reconciliation Deadline for an application and has received interim payments, the sum of those payments will become overpayments.
When there is an overpayment, CMS will initiate immediate overpayment recovery action.
If there is an overpayment, the Step 12: Review and Submit Reconciliation Payment Request page will display the Amount of Reconciliation Payment Request as a negative number in red font in parentheses.
The Plan Year Application Summary table displays the Net Total in the Subsidy Amount column for the entire application. If there is an overpayment, the Net Subsidy Amount will display as a negative number in red font in parentheses.
The Benefit Option Summary table displays the Net Subsidy Amount for each Benefit Option in the application. If there is an overpayment, the Net Subsidy Amount will display as a negative number in red font in parentheses.
The Amount of Reconciliation Payment Request and the Net Subsidy Amount will be the same.
When the Reconciliation Determination for an application is made, CMS' RDS Center will send an Overpayment Notification Email stating that a balance is due. A payment is due immediately upon receipt of the Overpayment Notification Email.
Note: An overpayment remittance may be sent to CMS' RDS Center as soon as the overpayment notification is received.
CMS' RDS Center will send notification emails regarding overpayments to the Plan Sponsor's Authorized Representative, Account Manager, and Designees with Appeal privileges.
The Plan Sponsor is responsible for satisfying all overpayments that occur.
CMS' RDS Center may send the following emails regarding overpayments to the Plan Sponsor's Authorized Representative, Account Manager, and Designees with Appeal privileges:
Emails about overpayments are sent from the email address: firstname.lastname@example.org.
Note: Emails should not be sent to this address. This is a notification-only email address and incoming email is not monitored. Sending an email to this address will not result in a response. Any assistance required by email should be directed to CMS' RDS Center.
A Plan Sponsor may submit an overpayment remittance in the form of a check or money order. No other methods of payment will be accepted by CMS' RDS Center.
Make the check or money order payable to: Centers for Medicare & Medicaid Services.
Include the Plan Sponsor ID on the check or money order.
Mail your check or money order to the following address:
Retiree Drug Subsidy Center
Attn: Payments - Box 6054
P.O. Box 7247
Philadelphia, PA 19170-6054
Note: This is the only mailing address for remitting a payment to CMS' RDS Center. However, Plan Sponsors also have the option of sending payments using certified mail through the United States Postal Service (USPS). Federal Express and UPS will not deliver certified mail to a PO Box address.
CMS' RDS Center will send a Check Acknowledgement Email to the Authorized Representative and Account Manager to confirm the receipt of the overpayment remittance on the day the check or money order is received.
CMS' RDS Center will deduct an overpayment from any positive interim payment requests or any positive final payment requests on another application with the same Plan Sponsor ID that is available.
If the amount of the positive payment request does not satisfy the entire overpayment, the Plan Sponsor will receive an Overpayment Notification of Change Email for the remaining balance.
If the positive payment request does satisfy the entire overpayment, then CMS' RDS Center will send an Overpayment Notification of Change Email stating that the overpayment is fully satisfied.
If an overpayment is offset by a positive payment request on another application, and then an overpayment remittance is received, CMS' RDS Center will refund the monies. The refund payment will be satisfied by Electronic Funds Transfer (EFT) to the account specified on the application. A Refund Notification Email will be sent to the Authorized Representative, Account Manager, and Designee with Appeal privileges to inform them that the monies have been returned.
If you have received an Overpayment Notification Email and have requested an appeal, you must remit payment. Until an appeal decision is made by CMS' RDS Center, the Overpayment Notification Email is considered the final Reconciliation determination, and payment must be remitted based on such determination.
Contact CMS' RDS Center to request a W-9 tax form.
The Centers for Medicare & Medicaid Services Employer Identification Number (EIN) is 52-0883104.
CMS reserves the right to refer outstanding amounts to the U.S. Department of Treasury for collection.
CMS reserves the right to assess interest on outstanding overpayment amounts. In such cases, Plan Sponsors will be informed before interest is assessed and notified of the interest rate.