| (a) For each specific RUG that is found to be in error
during the review and for which no timely and complete reconsideration
review was requested, OIG may direct the reclassification of the RUG
and recover an overpayment, or reimburse an underpayment, after the
reconsideration request deadline has passed.
(b) For each specific RUG for which a reconsideration
review was granted and for which no hearing was requested, OIG may
direct the reclassification of the RUG and recover an overpayment
after the hearing request deadline has passed.
(c) For each specific RUG for which a timely request
for a hearing is made, OIG may direct the reclassification of the
RUG and recover an overpayment after a final decision regarding the
appeal is issued.
(d) OIG may recover overpayments and reimburse underpayments
after due process has been concluded for all RUGs in the review.
(e) OIG may use statistical sampling and extrapolation
for nursing facility utilization review cases in accordance with §371.35
of this title (relating to Use of Statistical Sampling and Extrapolation).
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