195.995 Extrapolation Methodology in Medicare and Medicaid Postpayment Review:
MSSNY is:
(1) Petitioning the AMA to urge HCFA to adopt a policy that Medicare carriers just provide data which justify the statistical validity of their findings when any extrapolation technique is used in a Medicare post-payment audit and review process prior to any request for return of monies paid to physicians;
(2) Seeking statutory changes in the Medicare and Medicaid laws to prevent the application of the extrapolation methodology in order to ensure due process for physicians whose medical records and billing procedures are under review;
(3) Educating physicians in concert with local county medical societies about the potential abuses by Medicare and Medicaid administrators in carrying out reviews, and identifying legal resources which can be called upon by individual physicians for legal assistance and/or defense in cases of alleged Medicare/Medicaid fraud and abuse or overpayment. (HOD 1992-5 & 1992-76; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
