Statistical extrapolation valid method of determining overpayments.
Docket Number: 1331784 , Decision Date: July 31, 2013
Attachment: Click here to download the decision.
The Department of Community Health (DCH) recouped overpayments made to a dentist under the Medicaid and PeachCare for Kids programs where payments were for services that were inadequate to correct patients’ dental problems, were unsupported by radiographic documentation, and were for behavior management of an over-age child. DCH was permitted to use a statistically valid extrapolation technique in its audit of the dentist’s practice to determine the amount of overpayment.