§ 2-703. Limitations on the use of extrapolation

West's Annotated Code of MarylandHealth--GeneralEffective: October 1, 2016

West's Annotated Code of Maryland
Health--General
Title 2. Maryland Department of Health (Refs & Annos)
Subtitle 7. Use of Extrapolation in Recovery of Health Claim Overpayments (Refs & Annos)
Effective: October 1, 2016
MD Code, Health - General, § 2-703
§ 2-703. Limitations on the use of extrapolation
Currentness
In general
(a) On a finding of an overpayment to a provider, the Inspector General may not use extrapolation unless there is a determination of a sustained or high level of payment error, as defined by regulation.
Limitations on sample
(b) When using extrapolation to determine an overpayment, the sample to be used may not include claims:
(1) In which the alleged overpayment would have no fiscal impact on the entire sample;
(2) That were submitted in accordance with the Department's, Inspector General's, or program's directives, policies, guidelines, or regulations; or
(3) That are the result of an unintentional overlap in services among unrelated providers caused by circumstances beyond the control of the provider that is subject to the audit, in which case the Inspector General may recover the original overpayment.

Credits

Added by Acts 2016, c. 136, § 1, eff. Oct. 1, 2016.
MD Code, Health - General, § 2-703, MD HEALTH GEN § 2-703
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
End of Document