Program Integrity Manual - CMS

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Medicare Program Integrity Manual chapter 8 Administrative Actions and Sanctions and Statistical sampling for Overpayment Estimation Table of Contents (Rev. 11032, 09-30-21) Transmittals for chapter 8 Appeal of Denials Overpayment Procedures Overpayment Assessment Procedures Definition of Overpayment Assessment Terms Assessing Overpayment When Review Was Based on Statistical sampling for Overpayment Estimation Assessing Overpayment or Potential Overpayment When Review Was Based on Limited Sample or Limited Sub sample Contractor Activities to Support Assessing Overpayment Conduct of Expanded Review Based on Statistical sampling for Overpayment Estimation and Recoupment of Projected Overpayment by Contractors - Reserved for Future Use - Background on Consent Settlement - Opportunity to Submit Additional Information Before Consent Settlement Offer - Consent Settlement Offer - Option 1 - Election to Proceed to Statistical sampling for Overpayment Estimation - Option 2 - Acceptance of Consent Settlement Offer - Consent Settlement Budget and Performance Requirements for ACs Coordination with

determination to the MAC during specified times noted in Pub. 100-08, chapter 4, section 4.9.4. If a large number of claims are involved, contractors consider using statistical sampling for overpayment estimation to calculate the amount of the overpayment. (See section 8.4 …

  Chapter, Chapter 4, Sampling