cheapbag214s
Joined: 27 Jun 2013
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Location: England
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 Posted: Sun 2:13, 21 Jul 2013 Post subject: it may be successfully challenged |
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provider�s entire patient population. The MMA sets limits regarding when statistical extrapolation may be used, and the Medicare manuals establish guidelines for CMS to follow when performing an audit based upon a statistical sample. If an extrapolation is flawed, it may be successfully challenged, bringing the total dollars at issue to the �actual� alleged overpayment, and not the extrapolated alleged overpayment. For example, in one recent case challenged by this firm, CMS alleged an �actual� overpayment of approximately $28,000, which it then extrapolated to render its determination that the provider had been overpaid over $1.5 million. This firm was successful challenging the methodology of this statistical extrapolation and the extrapolation was overturned.Pursuant to Section 935 of the MMA:(1) LIMITATION ON USE OF EXTRAPOLATION. �A Medicare contractor may not use extrapolation to determine overpayment amounts to be recovered by recoupment, offset,[link widoczny dla zalogowanych], or otherwise,[link widoczny dla zalogowanych], unless the Secretary determines that �(A) there
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