Medicaid Audits: Challenging Statistical Sampling and Extrapolation

A live 90-minute CLE webinar with interactive Q&A


Wednesday, August 29, 2018 (in 11 days)

1:00pm-2:30pm EDT, 10:00am-11:30am PDT

or call 1-800-926-7926

This CLE webinar will prepare counsel for Medicaid providers to effectively evaluate and challenge the use of statistical sampling and extrapolation in audits seeking to establish overpayment amounts for recoupment.

Description

State Medicaid agencies are using statistical sampling and extrapolation to determine overpayments in their audits and investigations, as has long been the case in the Medicare program. A sample of claims is audited, and the results of that audit are extrapolated to the entire 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 onus 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 typically results in much less of a financial burden than the extrapolation.

Most state requirements, if there are any at all, for statistical sampling and extrapolation tend to de minimis in nature. To challenge state determinations of overpayment, Medicaid providers can look to Medicare rulings and cases for guidance. It is critical for Medicaid providers and their counsel to understand proper statistical sampling and extrapolation methods, and to know how to recognize questionable processes to facilitate a legal challenge.

Listen as our panel examines how statistical sampling is being used to recover Medicaid overpayments. The panel will also guide 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 high priority issues:

  • Primary considerations for Medicaid providers in working with counsel to challenge such overpayments
  • Proactive steps needed to properly mount the challenge
  • Data required to evaluate a state agency’s (or contractor’s) statistical sampling and extrapolation
  • Probability-related requirements of the methods and statistics being used
  • Benefits of having a statistical sampling and extrapolation expert on the case

Faculty

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

Ross, David
David R. Ross

Senior Shareholder
O’Connell and Aronowitz

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

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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:

CLE On-Demand Video

48 hours after event

$297

Download

48 hours after event

$297

DVD

10 business days after event

$297 + $9.45 S&H