In compliance and litigation settings, we are routinely confronted by an opposing party alleging some form of inappropriate conduct. Disputes often arise involving overpayment allegations, audits of insurance claims, or purported false claims and any of these allegations may invoke sampling and extrapolation as the basis for such claims.  In those cases, an aptitude for evaluating and disputing statistical sampling is valuable.  This is the second of a two-part series addressing techniques for scrutinizing sampling analysis.

In compliance and litigation settings, we are routinely confronted by an opposing party alleging some form of inappropriate conduct. Disputes often arise involving overpayment allegations, audits of insurance claims, or purported false claims, and any of these allegations may invoke sampling and extrapolation as the basis for such claims.  In those cases, an aptitude for evaluating and arguing statistical sampling analysis is valuable.  This is the first of a two-part series addressing techniques for scrutinizing sampling analysis.  arguing statistical sampling

There is considerable hesitancy in the healthcare industry to rely on statistical sampling for questions deemed subjective in nature, or when the sampling units in a population might be considered too unique.  This generally manifests when attempting to extrapolate liability in litigation, particularly in FCA matters.  For instance, conclusions about a patient’s medical eligibility and/or the medical necessity for hospice care have been disputed in recent years when sampling analysis was the basis for such conclusions.

While many providers repay millions of dollars to CMS recovery audit contractors (“RACs”), a growing number are employing successful appeal strategies, allowing them to overcome the government’s demands and retain their revenue … appealing overpayments and demands for overpayment