C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 456—UTILIZATION CONTROL › Subpart B—Utilization Control: All Medicaid Services

42 C.F.R. § 456.22

Sample basis evaluation of services

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To promote the most effective and appropriate use of available services and facilities the Medicaid agency must have procedures for the on-going evaluation, on a sample basis, of the need for and the quality and timeliness of Medicaid services.

Notes of Decisions
Cited in 5 cases, 1991–2017 · leading case: Goldstar Med. Servs., Inc. v. Dep't of Soc. Servs., 955 A.2d 15 (Conn. 2008).
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Goldstar Med. Servs., Inc. v. Dep't of Soc. Servs., 955 A.2d 15 (Conn. 2008). · cites it 3× “See 42 C.F.R. § 456.22 (“[t]o promote the most effective and appropriate use of available services and facilities the [m]edicaid agency must have procedures for the on-going evaluation, on a sample basis, of the need for and the quality and timeliness of [mjedicaid services”).”
Malloy v. State, 744 S.E.2d 778 (Ga. 2013). “42 USC § 1302 ; 42 CFR § 456.22 . The agency is also required to have methods and criteria for identifying suspected fraud cases.”
HCA Health Servs. of Kansas, Inc. v. State, Sec'y of Kansas Dep't of Soc. & Rehab. Servs., 900 P.2d 838 (Kan. Ct. App. 1994). · cites it 2× “42 C.F.R. § 456.22 (1993). Finally, federal law directs that the agency have a post-payment review process.”
Riverside Hosp., Inc. v. State Dep't of Soc. & Rehab. Servs., 808 P.2d 1348 (Kan. 1991). “” The use of sampling in Medicaid utilization control is authorized by 42 C.F.R. § 456.22 (1990), which provides: “To promote the most effective and appropriate use of available services and facilities the Medicaid agency must have procedures for the on-going evaluation, on a…”
Allen Dental Labs., Inc., App v. Washington State Health Care Auth., Resp (Wash. Ct. App. 2017). “38 The Ninth Circuit upheld the use of statistical sampling and extrapolation, observing: We now join other circuits in approving the use of sampling and extrapolation as part of audits in connection with Medicare and other similar programs, provided the aggrieved party has an…”
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