42 CFR 405.1064 : Public Health (Part 1 To Parts 1009-1099) — (Subpart A To § 413.355) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Subpart A To § 413.355) — Medicare Program (Subpart A To § 413.355) — Federal Health Insurance For The Aged And Disabled (Subpart A To § 405.2472) — Determinations, Redeterminations, Reconsiderations, And Appeals Under Original Medicare (Part A And Part B) (§ 405.900 To § 405.1140) — Applicability Of Medicare Coverage Policies (§ 405.1060 To § 405.1064) — ALJ decisions involving statistical samples.
4 Aug 2016
When an appeal from the QIC involves an overpayment issue and the QIC used a statistical sample in reaching its reconsideration, the ALJ must base his or her decision on a review of the entire statistical sample used by the QIC.