Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.6

Use of Other Sampling Methodologies

Last amended: 2019Year: 2019Length: 154 wordsOfficial source
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.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.1.6: Use of Other Sampling Methodologies | Justis AI