§ 2-701. Definitions.

MD Health-Gen Code § 2-701 (2019) (N/A)

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(a) In this subtitle the following words have the meanings indicated.

(b) “Claim” has the meaning stated in § 2–501 of this title.

(c) “Extrapolation” means the process of estimating an unknown value by projecting, with a calculated precision or margin of error, the results of the review of a sample to the universe from which the sample was drawn using a statistically valid sampling methodology.

(d) “Federal government” means an agency of the United States government or a contractor retained by the agency of the United States government.

(e) “Overpayment” means a payment that:

(1) Is made by the Department to a provider for services or goods for which the provider submitted a claim to the Department;

(2) Is found to be incorrect; and

(3) Results in a payment greater than that to which the provider is entitled.

(f) “Program” has the meaning stated in § 2–501 of this title.

(g) “Provider” has the meaning stated in § 2–501 of this title.

(h) “Statistically valid sampling methodology” means a methodology used for extrapolation that has a confidence level of 90% or greater and is validated by a statistician who possesses at least a master’s degree in statistics.

(i) “Universe” means a defined population of claims submitted by a provider to the Department and paid to the provider by the Department during a specified time period.

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§ 2-702. Use of extrapolation during audits to recover overpayments.