Section 16.05.07.100 - INVESTIGATION AND AUDITSInvestigation and audits of provider fraud, abuse, or misconduct conducted by the Department's Bureau of Compliance or its successor are governed under these rules.
01.Investigation Methods. Under Sections 56-209h(2) and 56-227(5), Idaho Code, the Department will investigate and identify potential instances of fraud, abuse, or other misconduct by any person related to or involved in public assistance programs administered by the Department. Methods may include: a. Review of computerized reports;b. Referrals to or from other agencies, health care providers, or persons;c. Conducting audits, interviews, and pre-payment and post-payment reviews;d. Probability sampling and extrapolation; ande. Issuing subpoenas to compel testimony or the production of records.02.Probability Sampling. Probability sampling will be done in conformance with generally accepted statistical standards and procedures. "Probability sampling" means the standard statistical methodology in which a sample is selected based on the theory of probability, a mathematical theory used to study the occurrence of random events.03.Extrapolation. Whenever the results of a probability sample are used to extrapolate the amount to be recovered, the demand for recovery will be accompanied by a clear description of the universe from which the sample was drawn, the sample size and method used to select the sample, the formulas and calculation procedures used to determine the amount to be recovered, and the confidence level used to calculate the precision of the extrapolated overpayment. "Extrapolation" means the methodology whereby an unknown value can be estimated by projecting the results of a probability sample to the universe from which the sample was drawn with a calculated margin of error.Idaho Admin. Code r. 16.05.07.100