Payment has been (denied for the/made only for a less extensive)
exclusion from the Medicare program. If you have any questions about this
notice, please contact this office.
service/item because the information furnished does not substantiate the
need for the (more extensive) service/item. If you have collected any
amount from the patient, you must refund that amount to the patient
within 30 days of receiving this notice. The requirements for a refund
are in 1834(a)(18) of the Social Security Act (and in 1834(j)(4) and
1879(h) by cross-reference to 1834(a)(18)). Section 1834(a)(18)(B)
specifies that suppliers which knowingly and willfully fail to make
appropriate refunds may be subject to civil money penalties and/or
