Medicare and Medicaid Audits Using Statistical Sampling and Extrapolation: Challenging Methods and Results
Recording of a 90-minute CLE webinar with Q&A
This CLE course will prepare counsel for healthcare providers to understand the demands of Medicare and Medicaid compliance audits and overpayment investigations. The panel will review sampling process and outline approaches for providers and their counsel to challenge overpayment extrapolations. They will explore critical steps to address requirements for self-report and to review extrapolation audits.
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 auditors extrapolate the overpayment amount
- 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 critical issues:
- 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 audit samples?
- What are the requirements for implementation and use of a statistically valid sample?
- 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
Ms. Grizzle focuses her practice on representing healthcare providers and companies in operational and compliance... | Read More
Ms. Grizzle 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.
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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
Dr. Maykuth is a statistical expert with particular skill in experimental design, statistical sampling and methodology. She has been President of her firm for over 30 years. In that role she conducts and oversees a variety of statistical analyses of consumer behavior, market analyses and projections of market trends. She has been involved in more than 150 civil and criminal trials relating to statistics and consumer attitudes and behaviors. She has been directly responsible for statistical review of over 120 Medicare and Medicaid fair hearing officer and Medicare and Medicaid administrative law judge hearings which involved the application of statistical sampling and projection techniques in audits of a variety of categories of health care providers and suppliers. Her firm is frequently engaged to assist providors conduct Voluntary Repayment estimations and in establishing criteria for measurement in quality based payment systems.
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