§ 2-701. Definitions

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, § 2-701
§ 2-701. Definitions
Currentness
In general
(a) In this subtitle the following words have the meanings indicated.
Claim
(b) “Claim” has the meaning stated in § 2-501 of this title.
Extrapolation
(c) “Extrapolation” means the process of estimating an unknown value by projecting, with a calculated precision or margin of error, the results of the review of a sample to the universe from which the sample was drawn using a statistically valid sampling methodology.
Federal government
(d) “Federal government” means an agency of the United States government or a contractor retained by the agency of the United States government.
Overpayment
(e) “Overpayment” means a payment that:
(1) Is made by the Department to a provider for services or goods for which the provider submitted a claim to the Department;
(2) Is found to be incorrect; and
(3) Results in a payment greater than that to which the provider is entitled.
Program
(f) “Program” has the meaning stated in § 2-501 of this title.
Provider
(g) “Provider” has the meaning stated in § 2-501 of this title.
Statistically valid sampling methodology
(h) “Statistically valid sampling methodology” means a methodology used for extrapolation that has a confidence level of 90% or greater and is validated by a statistician who possesses at least a master's degree in statistics.
Universe
(i) “Universe” means a defined population of claims submitted by a provider to the Department and paid to the provider by the Department during a specified time period.

Credits

Added by Acts 2016, c. 136, § 1, eff. Oct. 1, 2016.
MD Code, Health - General, § 2-701, MD HEALTH GEN § 2-701
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