Determine the total number of months the EU received an overpayment for each claim period.
- Calculate an AE claim back no more than twelve months including the month of discovery.
EXAMPLE: A possible overpayment for March 2003 through June 2003 is discovered on May 6, 2004. The 12-month look-back period is June 2003 through May 2004. A claim is established for the month of June 2003 only. Do not establish a claim for March 2003, April 2003, and May 2003.
- Calculate an IHE claim back no more than twenty-four months including the month of discovery.
EXAMPLE: A possible overpayment for March 2002 is discovered on May 6, 2004. The 24-month look-back period is June 2002 through May 2004. A claim is not established.
- A look back period of thirty-six months is allowed for SPV/IPV claims. If a suspected program violation overpayment month occurred within the thirty-six month look back period, calculate the overpayment back for seventy-two months. If there is no month in which an overpayment occurred due to the suspected program violation within the look back period, a claim amount is not calculated, and the discovery is rejected. The look back period includes the month of discovery.
EXAMPLE: A possible overpayment for March 2000 through June 2001 is discovered on May 6, 2004. The 36-month look-back period is June 2001 through May 2004. Since one of the months of the claim period falls into the 36-month look-back period, a claim is established for the entire claim period.