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<section article="ghg" article_name="Health - General" number="2-703" title_number="2" title_name="Maryland Department of Health" subtitle_number="7" subtitle_name="Use of Extrapolation in Recovery of Health Claim Overpayments">
  <level label="a">
    <text>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.</text>
  </level>
  <level label="b">
    <text>When using extrapolation to determine an overpayment, the sample to be used may not include claims:</text>
    <level label="1">
      <text>In which the alleged overpayment would have no fiscal impact on the entire sample;</text>
    </level>
    <level label="2">
      <text>That were submitted in accordance with the Department’s, Inspector General’s, or program’s directives, policies, guidelines, or regulations; or</text>
    </level>
    <level label="3">
      <text>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.</text>
    </level>
  </level>
</section>
