Montana § 53-6-1403 Extrapolation And Statistical Sampling Prohibited -- Exceptions

Montana Statutes

§ 53-6-1403 — Extrapolation And Statistical Sampling Prohibited -- Exceptions

Montana § 53-6-1403

Title 53SOCIAL SERVICES AND INSTITUTIONS

Ch. 6HEALTH CARE SERVICES

Part 14Medicaid Overpayment Audits

This text of Montana § 53-6-1403 (Extrapolation And Statistical Sampling Prohibited -- Exceptions) is published on Counsel Stack Legal Research, covering Montana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Mont. Code Ann. § 53-6-1403 (2026).

Text

53-6-1403 . Extrapolation and statistical sampling prohibited -- exceptions.

(1)Except as provided in subsection (2):

(a)in conducting an initial overpayment audit, the department or an auditor may not use statistical sampling extrapolation for automated reviews and may not rely on extrapolation to determine or support the amount of an overpayment determination; and

(b)an overpayment determination must be based on and supported by evidence of an overpayment for each claim.

(2)In an overpayment audit of a high-risk provider or a followup audit of any provider, the department or an auditor may use statistical sampling extrapolation for an automated review or may rely on extrapolation to determine or support the amount of an overpayment determination.

(3)The department or an auditor may

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53-6-1403 . Extrapolation and statistical sampling prohibited -- exceptions. (1) Except as provided in subsection (2):
(a) in conducting an initial overpayment audit, the department or an auditor may not use statistical sampling extrapolation for automated reviews and may not rely on extrapolation to determine or support the amount of an overpayment determination; and
(b) an overpayment determination must be based on and supported by evidence of an overpayment for each claim.
(2) In an overpayment audit of a high-risk provider or a followup audit of any provider, the department or an auditor may use statistical sampling extrapolation for an automated review or may rely on extrapolation to determine or support the amount of an overpayment determination.
(3) The department or an auditor may use data analysis techniques to identify claims that are most likely to contain overpayments for purposes of selecting providers or claims for overpayment audits.