Regulation 15 Repayment of direct paymentsI1
England and Wales
A health body may require that part or all of a direct payment must be repaid to the health body, if satisfied that it is appropriate to require repayment having regard in particular to whether—
the care plan has changed substantially;
the patient’s circumstances have changed substantially;
a substantial proportion of the direct payments received by a patient, representative or nominee have not been used to secure services specified in the care plan and have accumulated;
the direct payments have been used otherwise than for a service specified in the care plan;
theft, fraud or another offence may have occurred in connection with the direct payments; or
the patient has died.
Where a health body decides under paragraph (1) that a sum must be repaid, the health body must give reasonable notice in writing to the patient and any representative or nominee, stating—
the reasons for the decision;
the amount to be repaid;
the time within which the sum must be repaid; and
the person who must repay.
In the case of a patient who has died, the notice mentioned in paragraph (2) must be given to the personal representatives of the patient.
On receipt of a notice under paragraph (2), a patient, personal representative, representative or nominee may require a health body to re-consider the decision, and may provide evidence or relevant information for the health body to consider as part of that deliberation.
A health body must inform the patient and any personal representative, representative or nominee in writing of the decision on a re-consideration, stating the reasons for the decision, the amount to be repaid, if any, the time within which any sum must be repaid and the person who must repay, if any.
A health body may not be required to undertake more than one re-consideration following a decision under paragraph (1).
A health body may waive any requirement pursuant to a decision under paragraph (1) or (4) for part or all of a direct payment to be repaid.