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Title 42: Public Health
CHAPTER IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B: MEDICARE PROGRAM
PART 405: FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart I: Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)
: Applicability of Medicare Coverage Policies
405.1064 - ALJ decisions involving statistical samples.
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.
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