Page:United States Statutes at Large Volume 117.djvu/2429

 117 STAT. 2410

PUBLIC LAW 108–173—DEC. 8, 2003 ‘‘(ii) provide for a 45-day period during which the provider of services or supplier may furnish additional information concerning the medical records for the claims that had been reviewed. ‘‘(C) CONSENT SETTLEMENT OFFER.—The Secretary shall review any additional information furnished by the provider of services or supplier under subparagraph (B)(ii). Taking into consideration such information, the Secretary shall determine if there still appears to be an overpayment. If so, the Secretary— ‘‘(i) shall provide notice of such determination to the provider of services or supplier, including an explanation of the reason for such determination; and ‘‘(ii) in order to resolve the overpayment, may offer the provider of services or supplier— ‘‘(I) the opportunity for a statistically valid random sample; or ‘‘(II) a consent settlement. The opportunity provided under clause (ii)(I) does not waive any appeal rights with respect to the alleged overpayment involved. ‘‘(D) CONSENT SETTLEMENT DEFINED.—For purposes of this paragraph, the term ‘consent settlement’ means an agreement between the Secretary and a provider of services or supplier whereby both parties agree to settle a projected overpayment based on less than a statistically valid sample of claims and the provider of services or supplier agrees not to appeal the claims involved. ‘‘(6) NOTICE OF OVER-UTILIZATION OF CODES.—The Secretary shall establish, in consultation with organizations representing the classes of providers of services and suppliers, a process under which the Secretary provides for notice to classes of providers of services and suppliers served by the contractor in cases in which the contractor has identified that particular billing codes may be overutilized by that class of providers of services or suppliers under the programs under this title (or provisions of title XI insofar as they relate to such programs). ‘‘(7) PAYMENT AUDITS.— ‘‘(A) WRITTEN NOTICE FOR POST-PAYMENT AUDITS.—Subject to subparagraph (C), if a medicare contractor decides to conduct a post-payment audit of a provider of services or supplier under this title, the contractor shall provide the provider of services or supplier with written notice (which may be in electronic form) of the intent to conduct such an audit. ‘‘(B) EXPLANATION OF FINDINGS FOR ALL AUDITS.—Subject to subparagraph (C), if a medicare contractor audits a provider of services or supplier under this title, the contractor shall— ‘‘(i) give the provider of services or supplier a full review and explanation of the findings of the audit in a manner that is understandable to the provider of services or supplier and permits the development of an appropriate corrective action plan; ‘‘(ii) inform the provider of services or supplier of the appeal rights under this title as well as consent

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