Medicaid Audit Overpayments: Challenging Statistical Sampling and Extrapolation

Please note the start time will be 2:00 p.m. ET

Recording of a 90-minute CLE webinar with Q&A


Conducted on Wednesday, March 15, 2017

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will prepare counsel for Medicaid providers to effectively evaluate Medicaid overpayment sampling and extrapolations.

Description

State Medicaid agencies are using statistical sampling and extrapolation to determine overpayments in their audits and investigations, taking their guidance from the federal government, largely in the Medicare program. A sample of claims is audited and the results of that audit are extrapolated to the claims universe, resulting in substantial repayment demands on providers.

When facing an alleged overpayment, Medicaid providers generally have the burden of demonstrating that the reimbursement they received was proper. If the state Medicaid agency uses statistical sampling and extrapolation to establish the overpayment, the burden is on the provider to present sufficient evidence to refute the results of the sampling and extrapolation process. If the provider is successful, the extrapolated repayment amount will be removed from the case, leaving only the sample error and corresponding repayment to be challenged. This is typically much less of a financial burden than the extrapolation.

To challenge these state determinations of overpayment, Medicaid providers can look to Medicare rulings and cases for guidance. The rules of statistics need to be observed in order for an extrapolated result to be valid. It is critical for Medicaid providers and their counsel to understand proper statistical sampling and extrapolation methods, and to know how to challenge questionable processes to minimize potential repayment obligations.

Listen as our authoritative panel examines how states are using statistical sampling to recover Medicaid overpayments. The panel will also provide guidance to counsel for healthcare providers on how to challenge the sampling results and the alleged Medicaid overpayment, leveraging lessons from Medicare cases.

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Outline

  1. How states are using statistical sampling
    1. Methodology
    2. Requirements
  2. Challenging sampling results
    1. Attacking statistical validity
    2. Detecting flaws in the audit method
    3. Evidence rebutting results
    4. Expert testimony
    5. Leveraging guidance from Medicare cases

Benefits

The panel will review these and other key issues:

  • the primary considerations for Medicaid providers in working with counsel to challenge such overpayments;
  • the proactive steps needed to mount the challenge;
  • the data required to evaluate a state agency’s statistical sampling and extrapolation; and
  • the benefits of having a statistical sampling and extrapolation expert on the case.

Faculty

Ross, David
David R. Ross

Shareholder
O’Connell and Aronowitz

Mr. Ross concentrates his practice on Medicaid, Medicare and private insurance audits & investigations, and health...  |  Read More

Maykuth, Patricia
Dr. Patricia L. Maykuth, Ph.D
President
Research Design Associates

Dr. Maykuth is a statistical expert with particular skill in experimental design, statistical sampling and...  |  Read More

Other Formats
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Strafford will process CLE credit for one person on each recording. All formats include program handouts. To find out which recorded format will provide the best CLE option, select your state:

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