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Medicare Overpayment Extrapolations and How to Vastly Reduce Them

In a recent case Rivas Goldstein, LLP was able to significantly reduce a Medicare Overpayment for one of our clients. The client was faced with an initial recoupment of $5,459,933.90. This was based on Medicare’s claims that they had performed a “computer generated statistically valid random sample of claims.” The sample of claims that they referred to came from over a two year period with a total of 2,189 claims. From these claims they took a sample of 48 claims and, based on their statistical analysis of these claims, found errors and extrapolated them to come up with their final overpayment number due. Through the diligent work of the Rivas Goldstein team, we were able to receive a fully favorable decision on our argument that the extrapolation was invalid. This in turn altered the overpayment amount to only reflect the actual 48 claims that Medicare reviewed. At this point, the overpayment has been reduced from $5,459,933.90 all the way down to only $122,470.52. This was accomplished solely from the arguments we crafted to invalidate their extrapolation methods.