42 CFR § 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

---
identifier: "/us/cfr/t42/s411.22"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers."
title_number: 42
title_name: "Public Health"
section_number: "411.22"
section_name: "Reimbursement obligations of primary payers and entities that received payment from primary payers."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "411"
part_name: "EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn."
regulatory_source: "54 FR 41734, Oct. 11, 1989, unless otherwise noted."
cfr_part: "411"
---


# 411.22 Reimbursement obligations of primary payers and entities that received payment from primary payers.

(a) A primary payer, and an entity that receives payment from a primary payer, must reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to make payment.

(b) A primary payer's responsibility for payment may be demonstrated by—

(1) A judgment;

(2) A payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary payer or the primary payer's insured; or

(3) By other means, including but not limited to a settlement, award, or contractual obligation.

(c) The primary payer must make payment to either of the following:

(1) To the entity designated to receive repayments if the demonstration of primary payer responsibilities is other than receipt of a recovery demand letter from CMS or designated contractor.

(2) As directed in a recovery demand letter.

[71 FR 9470, Feb. 24, 2006, as amended at 73 FR 9684, Feb. 22, 2008]