(a) In this subtitle the following words have the meanings indicated. (b) “Claim” has the meaning stated in § 2–501 of this title. (c) “Extrapolation” means the process of estimating an unknown value by projecting, with a calculated precision or margin of error, the results of the review of a sample to the universe from which the sample […]
(a) Subject to the requirements of this subtitle, the Inspector General, or a contractor or an agent acting on behalf of the Inspector General, may use extrapolation during an audit to recover an overpayment from a provider if: (1) The federal government has also conducted an audit of the program for overpayment; and (2) The monetary recovery amount […]
(a) On a finding of an overpayment to a provider, the Inspector General may not use extrapolation unless there is a determination of a sustained or high level of payment error, as defined by regulation. (b) When using extrapolation to determine an overpayment, the sample to be used may not include claims: (1) In which the alleged overpayment […]
(a) The Inspector General or a contractor or an agent of the Inspector General that conducts an audit under this subtitle in which extrapolation may be used shall: (1) Perform the audit in accordance with a methodology used by the federal government or conducted in accordance with Generally Accepted Auditing Standards (GAAS) and the Statement on Accounting […]
(a) Not less than 15 calendar days before commencement of an audit by the Inspector General under this subtitle, the Inspector General shall give to the provider written notice of the audit, including: (1) The statistically valid sampling methodology to be used; (2) The name, contact information, and credentials of each individual conducting the audit, including the individual […]
