The Research Design Associates Blog

(extrapolation)

Help for Audited Medicare Providers

CMS contractors audit providers of Medicare services on a contingency-fee basis to find improper overpayments. With intense pressure to investigate fraud, and audit contractors incentivized with contingency fees to find improper overpayments, the audit system itself is ripe for error and abuse. Statistical analysts at Research Design Associates have expertise in challenging the sampling and extrapolation process. Often working with law firms representing providers in Medicare overpayment disputes, we investigate every phase of the process. Errors in sampling design and/or statistical analysis can generate hundreds of thousands of dollars of incorrect extrapolated overpayments. It is worthwhile considering a challenge to audit statistical methodology since a successful challenge could nullify the extrapolation.

Read more …

1.16.2012

RAC Attacks: The Current Landscape of Medicare Audits

Improper payments for health care are estimated to range between 3% and 10% of total health care expenditures nationally. The Medicare program has introduced “recovery audit contracting” (RAC) as a way of assuring that proper payments are being made for services, identifying fraud and abuse. The goal is to reduce fraud during 2009 to 2012 by 50%. With intense pressure to investigate fraud and audit contractors incentivized with contingency fees to find improper overpayments, the audit system itself is ripe for error and abuse.

Read more …

1.10.2012