Medicaid Audits: Challenging Statistical Sampling and Extrapolation
Recording of a 90-minute CLE webinar with Q&A
This CLE course 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.
Outline
- How states are using statistical sampling
- Methodology
- Requirements
- Challenging sampling results
- Attacking statistical validity
- Detecting flaws in the audit method
- Evidence rebutting results
- Expert testimony
- 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
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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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
Mr. Ross concentrates his practice on Medicaid, Medicare and private insurance audits & investigations, and health law including fraud and abuse, governmental investigations, criminal defense, administrative hearings, Federal and State False Claims whistleblower cases, Medicaid compliance plans, and Article 78 cases. He is the head of the firm's Government Investigations Unit and a member of the Healthcare Fraud and Abuse Unit. He held a number of high ranking positions within New York State government, including being appointed as General Counsel of the Office of the Medicaid Inspector General (OMIG) when the OMIG was created in response to widespread public concern about Medicaid fraud, waste and abuse. In addition to serving the OMIG as General Counsel, he was the Deputy Medicaid Inspector General for Audits and Investigations and oversaw all audits and investigations involving Medicaid providers.
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