Medicare and Medicaid Audit Sampling Strategies
Developing Sampling Plans and Challenging Flawed CMS Audit Samples
Recording of a 90-minute CLE webinar/teleconference with Q&A
Conducted on Tuesday, August 14, 2012
Recorded event now available
This CLE webinar will prepare counsel to healthcare providers to meet the demands of Medicare and Medicaid compliance audits and overpayment investigations. The panel will review the sampling process and outline approaches for providers and their counsel to challenge overpayment extrapolations.
Description
Medicare Zone Program Integrity Contractors (ZPICS) f/k/a Program Safeguard Contractors (PSCs) and Medicaid Fraud Control Units sample and analyze claims, extrapolate overpayments, and identify fraud to return the money to the Medicare Trust Fund. In many cases, auditors uncover poor documentation to support claims and not only deny the claims but use the sample results to support the application of an extrapolated overpayment.
Because of the significant dollar amounts at stake, providers facing an extrapolated overpayment should analyze the sampling methodology and determine the defenses available for challenging the statistical work. If the extrapolation is invalidated, the healthcare provider may be required to repay only the amount determined from the sample of claims examined, instead of the entire extrapolated overpayment. For the provider, this could mean paying back several thousand dollars instead of several million dollars.
Listen as our authoritative panel of healthcare attorneys and statistics experts examine Medicare and Medicaid audit sampling and extrapolation and outline ways to mount an appeal on behalf of the healthcare provider charged with receiving overpayments on claims.
Outline
- Medicare fraud and the government’s use of for-profit auditors
- Designing and implementing sampling and extrapolation plans
- Purpose of sampling
- Key terminology
- Sample size
- Stratification
- How the overpayment is extrapolated
- The appeals process and discovery
- Strategies to contest overpayment extrapolations
- Detecting flaws in the audit method
- Challenging improper samples
- Challenge procedural fairness requirements
- Raising sampling issues in the appeals process
Benefits
The panel will review these and other key questions:
- What is the legal basis for challenging the use of statistical sampling and extrapolation?
- What are the proactive steps the healthcare provider can take to ensure there is sufficient data to mount a defense against the extrapolation?
- What types of data sampling flaws and procedural fairness issues support an effective challenge to CMS audit samples?
- What are the key considerations for healthcare providers in working with counsel to defend against an audit finding overpayments?
Faculty
Anna M. Grizzle, Member
Bass Berry & Sims, Nashville, Tenn.
She focuses her practice on representing healthcare providers and companies in operational and compliance matters, investigations, and litigation. She works with clients to develop policies in anticipation of government and commercial payor claims audits and represents clients in responding to claims audits and in the appeals of audit results.
Patricia L. Maykuth, Ph.D, President
Research Design Associates, Decatur, Ga.
She has been involved in Medicare fair hearing officer and Medicare administrative law judge hearings, as well as Medicaid appeals involving statistical sampling and projection techniques used by governmental payors affecting a variety of categories of healthcare providers and suppliers. She has also been involved in over 120 civil and criminal trials consulting in statistics.
Ordering
Online CLE - Audio Recording
Includes streaming audio of full program plus handouts (available 24 hours after live program).
CLE:
Pre-approved for participatory or non-traditional/alternate format credit in: CA, HI*, NY*, WV*.
Pre-approved for self-study credit in: AK, AZ, MO, MT, TX*, VT, WA.
Upon request, also available in: CO, CT*, FL, GA, ID, KY, LA*, ME, NC, ND, NE, NH, NM, NV, OR*, SC, TN, UT, WI, WY. If you are applying for credit in one of these states, make sure to select those states when placing your order.
(*Indicates that Strafford must report attendance.)
Online CLE Audio $297.00
Available 24 hours after the live event
Recorded Event
Includes full event recording plus handouts (available after live seminar).
CLE: Pre-approved for self-study credit in: AK, AZ, CA, CT, HI, MO, MT, NY, TX*, VT, WA, WV. Upon request, self-study credit is also available in: CO, FL, GA, ID*, KY, ME, ND, NE, NH, NM, NV, OR, UT, WI, WY. If you are applying for self-study credit in one of these states, contact Strafford CLE at 1-800-926-7926 ext. 35 or CLE@straffordpub.com. (*Indicates that Strafford needs to process the CLE — see below to purchase this option.)
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Available three business days after the live event
DVD (Slide Presentation with Audio) $297.00
plus $9.45 S&H
Available ten business days after the live event
MP3 Download (Audio with Slide PDFs) $297.00
Available 24 hours after the live event
CD (Audio with Slide PDFs) $297.00
plus $9.45 S&H
Available ten business days after the live event
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Program Materials
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Program Materials
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CLE Credit
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Customer Reviews
Very current topic and I appreciated the real life examples.
Lisa Thompson
Adelman Sheff & Smith
Well prepared and well presented information.
Ron Brandenburg
Quinlivan & Hughes
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Brian McNamara
Wright Lindsey & Jennings
The teleconference was efficient with a well-focused agenda. The speakers really seem to know the material and communicated it clearly.
Owen Hughes
Pfizer
I liked that the slides automatically moved along with the presentation of each speaker.
Ann Marie Henderson
Staten Island University Hospital
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