Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.6
Use of Other Sampling Methodologies
8.4.1.6 - Use of Other Sampling Methodologies
(Rev. 906; Issued: 09-26-19; Effective: 01-02-19; Implementation: 01-02-19)
Once it is has been determined that statistical sampling may be used, nothing in these
instructions precludes CMS or its contractor from relying on statistically sound sampling
methodologies employed by other law enforcement agencies, including but not limited to
the OIG, the DOJ, and/or the FBI. In these cases, a full explanation shall be provided
explaining why the methodology was used and why it was statistically appropriate in the
circumstances.
Where it is foreseen that the results of a contractor’s review may be referred to law
enforcement or another agency to support litigation or other law enforcement actions, the
contractor shall discuss specific litigation and/or other requirements as they relate to
statistical sampling with its statistical expert prior to undertaking the review to ensure
that the review will meet their requirements and that such work will be funded
accordingly.