North Carolina Administrative Code (Last Updated: November 13, 2014) |
TITLE 10A. HEALTH AND HUMAN SERVICES |
CHAPTER 22. MEDICAL ASSISTANCE ELIGIBILITY |
SUBCHAPTER F. PROGRAM INTEGRITY |
10A NCAC 22F .0606. TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTS
Latest version.
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(a) The Medicaid agency will seek restitution of overpayments made to providers by the Medicaid program.
(b) The agency may use a Disproportionate Stratified Random Sampling Technique in establishing provider overpayments.
(c) This technique is an extrapolation of a statistical sampling of claims used to determine the total overpayment for recoupment.
(d) The provider may challenge the validity of the findings in the SAMPLE itself in accordance with the provisions found at 10A NCAC 22F .0402.
History Note: Authority G.S. 108A‑25(b); 108A‑54; 108A‑63; 42 C.F.R. Part 455;
Eff. October 1, 1987;
Temporary Amendment Eff. November 8, 1996;
Amended Eff. August 1, 1998.