Common use of Full Sample Clause in Contracts

Full Sample. If the Discovery Sample 1 indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample 1) using commonly accepted sampling methods. If the Discovery Sample 2 indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample 2) using commonly accepted sampling methods. The Paid Claims selected for the Full Sample 1 or Full Sample 2 shall be reviewed based on supporting documentation available at the Friendship Entities or under the Friendship Entities’ control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of Full Sample 1 or Full Sample 2, the Discovery Samples may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Samples, and the corresponding findings for those Paid Claims, as part of its Full Samples, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Samples. The findings of the Full Samples shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Samples (and any related workpapers) received from the Friendship Entities to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.