consent settlement
(5) Consent settlement reforms (A) In general The Secretary may use a consent settlement (as defined in subparagraph (D)) to settle a projected overpayment. (B) Opportunity to submit additional information before consent settlement offer Before offering a provider of services or supplier a consent settlement, the Secretary shall— (i) communicate to the provider of services or supplier— (I) that, based on a review of the medical records requested by the Secretary, a preliminary evaluation of those records indicates that there would be an overpayment; (II) the nature of the problems identified in such evaluation; and (III) the steps that the provider of services or supplier should take to address the problems; and (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.