Section 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- (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