Fees for medical services; disputes; effect of adverse decision

If the final decision and order upholds the finding of the Director that the fee or charge in
dispute was not in accordance with prevailing community charges or the provider’s customary
charges, the person claiming such fee or cost charge shall be given thirty (30) days after filing of
such decision and order to make the necessary adjustment. If such person still refuses to make the
required readjustment, such person shall not be authorized to conduct any further treatments or
examinations (if a physician) or to provide any other services or supplies (if by other than a
physician). Any fee or cost charge subsequently incurred for services performed or supplies
furnished shall not be a reimbursable medical expense under this subpart. This prohibition shall
apply notwithstanding the fact that the services performed or supplies furnished were in all other
respects necessary and appropriate within the provision of these regulations. However, the Director
may direct reimbursement of medical claims for services rendered if such services were rendered in
an emergency (see § 702.435(b)). At the termination of the proceedings provided for in this section
the district director shall determine whether further proceedings under § 702.432 should be initiated.
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