Statistical Analysis & Sampling

Statistical analysis, sampling and extrapolation are growing tools in the struggle to minimize cost and effort when collecting data and evidence in litigation. Forensus provides comprehensive services to develop independent sampling methodologies and to scrutinize opposing analyses.  Our expert statisticians are also published in a variety of industry resources – See more insights on our Statistical Sampling and RAT-STATS blog; the RAT-STATS Advisor. sampling expert witness

Given the recent emphasis on statistical analysis in False Claims Act matters, it is increasingly likely courts and juries will hear and decide the merit of complex statistical evidence. Our team of expert statisticians has delivered expert witness testimony in U.S. federal courts on the topic of statistical analysis and we recognize the importance of providing objective and articulate opinions. We also understand the unique workings of sampling and extrapolation in healthcare settings and we offer distinctive experience when addressing such FCA matters. sampling expert witness

Our team of expert statisticians has published numerous articles on the topic of sampling and extrapolation in FCA matters and we regularly provide hands-on training for our colleagues and clients. sampling expert witness

Representative Casework

Criminal Healthcare Fraud – Expert Testimony

Testified as an expert in U.S. District Court rendering opinions on forensic accounting and statistical analysis related to allegations of criminal healthcare fraud. Statistically sampled and analyzed medical equipment billing and coding records along with patient medical records to identify indicia of fraud and to calculate financial damages.  We analyzed over 100,000 lines of hospital billing data to determine the amount of reimbursement from Medicare/ Medicaid related to the doctors and practice groups in question.

False Claims Act – Sampling and Chart Review

Our team led the forensic accounting analysis of whistleblower allegations at a leading national therapy provider. The provider was an active acquisition target throughout the investigation. Allegations included improper application of billing codes and overbilling of third party payers in excess of $25 million over three years. We designed and selected a Statistically Valid Random Sample (SVRS) of patient records from over two million visits to quantify improper billings, assess patterns in billing activity, and extrapolate results of the sample. Prepared and presented summary analysis to clients and counsel, potential acquirers, and the state’s Attorney General’s office.

Statistical Sampling & Extrapolation

Retained as a consulting expert on behalf of a Fortune 500 hospice provider to design and select a statistically valid random sample (SVRS) of patient claims. Implemented stratification and cluster sampling and worked closely with clinical experts to extrapolate decisions of medical necessity.

CMS Repayment Appeals – Expert Report

Retained on multiple occasions as a testifying expert on behalf of a physician practices to assess the statistical validity and conclusions of Centers for Medicare and Medicaid Services (CMS) demands for repayment. Authored expert reports in support of the practice’s repayment appeal. chris haney

Training Program – Practical Use of RAT-STATS

A key tool in the Government’s arsenal is RAT-STATS statistical software, which is used to sample and quantify improper claims, which then become the basis for damages and monetary penalties. This training offers a hands-on discussion of RAT-STATS, including a detailed discussion of sampling and extrapolation. This workshop is an effective “how-to” for your audit and compliance teams. Our team has provided this training to multiple health systems, auditors, and government investigators.

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