Opinion ID: 768808
Heading Depth: 3
Heading Rank: 2

Heading: Subsection 1395gg(b)

Text: 21 Subsection 1395gg(b)(3) dovetails with sec. 1395gg(a). Adjustments to payments made under sec. 1395gg(b) are to payments to which such individual is entitled. 42 U.S.C. sec. 1395gg(b)(3) (emphasis added). The entitlement to payments under sec. 1395gg(b) is the individual's, not the provider's. 22 The language of sec. 1395gg(b)(1) also indicates that Congress did not intend to create any rights for providers. As set out above, sec. 1395gg(b)(1) allows adjustments to be made to payments where: 23 more than the correct amount is paid under this subchapter to a provider of services or other person for items or services furnished an individual and the Secretary determines (A) that, within such period as he may specify, the excess over the correct amount cannot be recouped from such provider of services or other person, or (B) that such provider of services or other person was without fault with respect to the payment of such excess over the correct amount . . . . 24 42 U.S.C. sec. 1395gg(b)(1). The language merely creates prerequisites for the adjustments in payments to the individual beneficiaries. Subsection 1395gg(b)(1)(A) allows the Secretary to recover money from individuals directly if she cannot recover it from the provider of services. 5 According to sec. 1395gg(b)(1)(B), if the provider of services was without fault in the overpayment, adjustment may be made to the individual's payment. These subsections, sec. 1395gg(b)(1)(A) and (B), set forth the conditions precedent that must be satisfied before recovery from an individual may be undertaken; they do not create any entitlement to funds on the part of the providers.