tci Medicare Compliance & Reimbursement - 2018 Issue 8

Industry Note: OIG Adds Statistical Sampling To Work Plan

If you thought claims reviews were getting tougher, you were right. Medicare auditors with the ability to pull statistical samples may soon strike fear in providers' hearts. The HHS Office of Inspector General (OIG) is tackling the topic of statistical sampling in a newly announced Work Plan topic. "Medicare program integrity contractors are authorized to use statistical sampling to identify and recover improper payments. Providers may contest these statistical estimates through the administrative appeals process," the OIG says on its website. "If a statistical estimate is overturned during the administrative appeals process, then the provider is liable for...

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