Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.4.9
Changes Resulting From Appeals
8.4.9 - Changes Resulting From Appeals
(Rev. 906; Issued: 09-26-19; Effective: 01-02-19; Implementation: 01-02-19)
If the decision issued on appeal contains either a finding that the sampling methodology
was invalid or reverses the revised initial claim determination, the contractor shall take
appropriate action to adjust the estimation of overpayment with the revised input of the
statistical expert who created the initial methodology or the revised input of another
statistical expert supplied by the contractor should the creator of the initial methodology
no longer be available.