Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.2
Assessing Overpayment When Review Was Based on Statistical
8.2.2 – Assessing Overpayment When Review Was Based on Statistical
Sampling for Overpayment Estimation
(Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16)
If contractors use statistical sampling for overpayment estimation of claims, they follow
instructions in section 8.4 of this chapter to calculate the valid projected overpayment.
They document the sampling methodology when review is based on statistical sampling
for overpayment estimation. They notify the provider/supplier of the overpayment and
refer the case to overpayment staff to make payment arrangements with the
provider/supplier to collect the overpayment.