A recent decision by an administrative law judge for New York State’s Department of Health has dealt a setback to the Office of Medicaid Inspector General and its use of “extrapolation” of claims sampling in calculating Medicaid repayment demands. The decision has been widely circulated in the provider community, where it was received with considerable satisfaction. But the case is not so simple, and closer attention to its findings should instead provide a sobering warning to providers about the real financial perils of not complying with the Medicaid program’s detailed documentation requirements.
BACKGROUND
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