C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER A—GENERAL PROVISIONS › PART 402—CIVIL MONEY PENALTIES, ASSESSMENTS, AND EXCLUSIONS › Subpart B—Civil Money Penalties and Assessments

42 C.F.R. § 402.109

Statistical sampling

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(a) Purpose. CMS or OIG may introduce the results of a statistical sampling study to show the number and amount of claims subject to sanction under this part that the respondent presented or caused to be presented.

(b) Prima facie evidence. The results of the statistical sampling study, if based upon an appropriate sampling and computed by valid statistical methods, constitute prima facie evidence of the number and amount of claims or requests for payment subject to sanction under § 402.1.

(c) Burden of proof. Once CMS or OIG has made a prima facie case, the burden is on the respondent to produce evidence reasonably calculated to rebut the findings of the statistical sampling study. CMS or OIG then has the opportunity to rebut this evidence.

Notes of Decisions
Cited in 1 case, 2018–2018 · leading case: Counseling Ctr., Inc. v. N.M. Human Servs. Dep't, 429 P.3d 326 (N.M. Ct. App. 2018).
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Counseling Ctr., Inc. v. N.M. Human Servs. Dep't, 429 P.3d 326 (N.M. Ct. App. 2018). “§ 108C-5(n)(2) (West 2014) (stating that a provider may challenge error rate of extrapolated audit results by either conducting a one-hundred percent file review or conducting a second audit upon a sample chosen by the [d]epartment); 42 C.F.R. § 402.109 (c) (2012) (providing…”
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