CMS Pub. 100-08, ch. 8, § 8.4.9.1

If the decision issued on appeal contains a finding that the sampling methodology was

invalid, there are several options for revising the estimated overpayment based upon the

appellate decision:

A. If the decision issued on appeal permits correction of errors in the sampling

methodology, the contractor shall revise the overpayment determination after

making the corrections. The contractor shall consult with its BFL, with a copy to

the COR, to confirm that this course of action is consistent with the decision of the

MAC, Qualified Independent Contractor (QIC), Administrative Law Judge (ALJ),

Medicare Appeals Council (the Council) within the Departmental Appeals Board

(DAB), or Federal District Court.

B. The contractor may elect to recover the actual overpayments related to the

sampled claims and then initiate a new review of the provider or supplier. If the

actual overpayments related to the sampling units in the original review have been

recovered, these individual sampling units shall be eliminated from the sampling

frame used for any new review. The contractor shall consult with its BFL, with a

copy to the COR, to confirm that this course of action is consistent with the

decision of the MAC, QIC, ALJ, the Council or Federal District Court.

C. The contractor may conduct a new review (using a new, valid methodology) for

the same time period covered by the previous review. If this option is chosen, the

contractor shall not recover the actual overpayments on any of the sample claims

found to be in error in the original sample. Before employing this option, the

contractor shall consult with its BFL, with a copy to the COR, to verify that this

course of action is consistent with the decision of the MAC, QIC, ALJ, Council, or

the Federal District Court.