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CMS-64.9O

ICR 202611-0938-007 · OMB 0938-1265 · Object 174882000.

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Record metadata
File Type	application/pdf
File Title	CMS-64.9O
Last Modified By	Data Dynamics ActiveReports (tm) for .NET
File Modified	2026-11-05
File Created	2026-11-05
Conversion State	complete

Extracted Text

Quarter Ended:
Department
of Health and Human Services
Centers for Medicare & Medicaid Services

OMB No. 0938-1265
Expires 07/31/2027

Medicaid Overpayment Adjustment
State:
Total

Overpayment Activity
1 Overpayments Not Collected Or
Adjusted But Refunded Because Of
The Expiration Of The 1 Year Time
Limit

2 Decreasing Adjustments To Amounts
Previously Reported On Line 1

Federal Share

Total

Computable

FY 2023 And
Prior

FY 2024

FY 2025

FY 2026

(A)

(B)

(C)

(D)

(E)

0

0

0

COVID:

0 COVID:

0

VIII:

0 VIII:

0 VIII:

0

0

0

COVID:

0 COVID:

0

VIII:

0 VIII:

Federal
(F)

0

0

0 VIII:

0

0

0

0 VIII:

0 VIII:

0

0

0

0

0

COVID:

0 COVID:

0

VIII:

0 VIII:

0 VIII:

0 VIII:

0

0

COVID:

0

VIII:

0
0

COVID:
VIII:

3 Subtotal

4 Previously Reported Overpayments
To Providers Certified This Quarter
As Bankrupt Or Out Of Business

0

0

0

0

0

0

COVID:

0 COVID:

0

VIII:

0 VIII:

0 VIII:

0 VIII:

0

0

0

0

0

COVID:

0 COVID:

0

VIII:

0 VIII:

0 VIII:

0 VIII:

0

Form CMS 64.9O

0

0
0

COVID:

0

VIII:

0
0

COVID:
VIII:

5 Total Overpayment Adjustments This
Quarter

0

0
0
0

COVID:

0

VIII:

0

Thursday, November 05, 2026 - 01:09 PM