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B-164031(3).125 1 (1977-11-07)

handle is hein.gao/gaobadffd0001 and id is 1 raw text is: I .CTOM COMPTLLEN WENMrtAL 6. n DECISIO3N * ._ . cOF THE UNITRD *TATWE W otHWASHINJtYON. D. C. 20 545 FILE: 1g . DATE: noY 7 B*184001( ).125 *MATTER OF: I4anwood Mvnor Health Care Center-Medici Overpayments DIGEST: GAO Is prohibited from reviewing reasonable cost determinations under Medicare Progranifor use by provider in, or to collatcrally attack, specific administrztive adjudication or dctcrminatlon by Secretary of I:W or his agent, due to apecific language of 42 U.S. C. S 40-(h), made applicable to Medicare Program by 42 LT.S.C. 5 139511, pro- hibiting any governmental agency from reviewing findings of fact or decisions of Secretary, except where otherwise pcovlded. This decision in in reponne to an appert filed by Mr. Gordon I1. Flattum, attorney-mn-fact for Lynnwood Manor Health Care Ceiter. Lynnwood, Wt shington, from an opinion of settlement of the Claimr. Diviston of the United States Ccneral Accounting Office concluding that $7, 728 vwas due 1the United States. The aflgd debt aroEc as the result of the participation of Lynnwacd M' nor Ecailth C.rc Center, Provider No. 50-3102, in the Medicare Progrr.m of the Social 1ecuriLy Act, 42 U.S.C. 5 1305 et seq., during the period Jrrinary 1, 1C07 to November 2, 1GO. Mi1rences hereafter, unless etherwise noted, will be to seztions of Title 42, U.S.Code.) TUder the Medcare Program, a providcr (130O5x(u) of covered services may i*ptaJd the reasonable coat of such strvices (13031(b)), au dcte--mincd 'pursuant to subsection 1305$(v) and the appropriate regulationa (20 C.F.R. 5 405.401 Lt zec.), from the Federal Hospital inisuranoc Trust Pund (18T5) a of charging the breneficiary paticint (1305cc(n)(1)(A)L, other thn for certain stated exceptions, incliuding co-innurance wnd deductible, pro- vided for In section 18nsc~a(2)(A). Jnotead of receiving payments directly from the Pripartment of Hen1th, Lducation, and it clfare S(EW), a frovidcr mrty nominate a public or private organization to act as a fiscal intcrmediary, and the Secretcry of E1J- is autho- rized to enter Lito an agreement with such orgrtnantion providing, inter aV.a, for the. determinationby such organiotion of the amount ST oF T s due the provider and the nalding c.a cuch payments to the provider on behalf of T1YW. (1305h(a)). Prynents arc to be made to the provider not less often than monthly (1395g). and In- torim payments may tr made prior to incurrn:; of asaociated costs, with any necessary adjustments on account of previously made over- payments and undorpayrents to be made on a retroactive basis at i -1- q

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