10A NCAC 22F .0606        TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTS

(a)  The Medicaid agency will seek restitution of overpayments made to providers by the Medicaid program.

(b)  The agency may use a Disproportionate Stratified Random Sampling Technique in establishing provider overpayments.

(c)  This technique is an extrapolation of a statistical sampling of claims used to determine the total overpayment for recoupment.

(d)  The provider may challenge the validity of the findings in the SAMPLE itself in accordance with the provisions found at 10A NCAC 22F .0402.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54; 108A‑63; 42 C.F.R. Part 455;

Eff. October 1, 1987;

Temporary Amendment Eff. November 8, 1996;

Amended Eff. August 1, 1998.