Form VA 21-0781 2017-2022

B) Nothing in this section shall be construed as establishing for a State any rights to a refund of payments made under this part if the Secretary finds that such refund or payment is improper based on a determination that the State is knowingly engaging in a fraud or to which such refund or payment is made for the benefit of the claimant, as determined by the Secretary. [81 FR 27441, May 28, 2016] Subpart F—Federal Claims Appeals and Disputes Source: 77 FR 24897, May 1, 2012, unless otherwise noted. §3560.1 Scope. This subpart establishes the scope of the requirements for a claimant's eligibility to file an appeal with the Secretary and the procedure for a claim to be denied. §3560.2 Definitions. For purposes of this subpart: Beneficiary means a person who receives payment for a covered service from a third-party payer. Claim consists of any claim for a failure by a third-party payer not subject to the requirements in part 60 of this subpart. Claimant means the person entitled to payment for a covered service (or a beneficiary under a group health plan for which claims are reviewed) based on a claim for a failure to pay or to fulfill a contract. The term also includes any health care provider. The Secretary means the Secretary of Veterans Affairs. The Secretary may conduct a separate appeal or a single review for a given covered service (or group health plan with respect to a given beneficiary) only to the extent the provisions of this subpart would otherwise apply in a review. Claimed means any person who, based on a claim: (i) is entitled to reimbursement for a covered service furnished by the Federal Government; or (ii) is an individual under group health care plans that the Secretary is authorized to administer or contract with under the federal Employee Retirement Income Security Act of 1974 (Public Law 94-171; 26 U.S.C.