Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3
Assessing Overpayment or Potential Overpayment When Review
8.2.3 – Assessing Overpayment or Potential Overpayment When Review
Was Based on Limited Sample or Limited Sub-sample
(Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16)
If a limited sample or limited sub-sample of claims is chosen for review, there are two
overpayment assessment options for contractors:
•
Refer to overpayment staff for recoupment of the actual overpayment for the
claims reviewed; or
•
Conduct an expanded review based on statistical sampling for overpayment
estimation instructions in section 8.4 of this chapter and recoup the projected
overpayment.