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<section article="ghg" article_name="Health - General" number="2-704" 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>The Inspector General or a contractor or an agent of the Inspector General that conducts an audit under this subtitle in which extrapolation may be used shall:</text>
    <level label="1">
      <text>Perform the audit in accordance with a methodology used by the federal government or conducted in accordance with Generally Accepted Auditing Standards (GAAS) and the Statement on Accounting Standards (SAS);</text>
    </level>
    <level label="2">
      <text>Use a statistically valid sampling methodology; and</text>
    </level>
    <level label="3">
      <text>Meet the following qualifications:</text>
      <level label="i">
        <text>Have at least 3 years of auditing experience;</text>
      </level>
      <level label="ii">
        <text>Have experience in the procedural coding program used for the claim;</text>
      </level>
      <level label="iii">
        <text>Be familiar, either independently or through training by the provider, with the format and content of paper and electronic medical records and claim forms used by the provider; and</text>
      </level>
      <level label="iv">
        <text>Have general knowledge of the particular health care item or service that is the subject of the audit and the program rules that govern the health care item or service at the time the item or service was provided.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>If the medical necessity of the claim is the subject of the audit, the entity that conducts the audit shall include as part of the audit team an individual licensed in the same health occupation as the provider.</text>
    </level>
    <level label="2">
      <text>The individual included in the audit team under paragraph (1) of this subsection shall have significant knowledge of the audited procedure but is not required to be in the same specialty or practice area as the audited provider.</text>
    </level>
  </level>
</section>
