Statistical sampling analysis is most commonly used when one seeks to infer useful information about a relatively large population without examining every unit in the population by examining only a subset of that population (i.e. a sample).  As part of sampling analysis, estimation or extrapolation is a procedure by which measured characteristics of a sample yield estimates, inferentially, about unknown characteristics of the population from which the sample was drawn …

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.

Statistical sampling is routinely used in audits and investigations when seeking to reach conclusions about large volumes of data.  A probe sample can be a key tool in increasing the efficiency and reducing the cost of statistical sampling analysis.  A probe sample can also be helpful in identifying risk and quickly evaluating whether a full statistical sampling is required. 

Statistical sampling and extrapolation are routinely accepted as evidence to estimate damages, and established methodologies to design and implement valid sampling studies are well-known.  Yet the role and propriety of a given analysis in litigation continues to be hotly contested. The reasonableness of an extrapolated loss calculation was a significant sentencing issue in United States v. Solomon Melgen, Case No. 9:15-cr-80049, in the United States District Court for the Southern District of Florida … extrapolating losses in healthcare fraud sentencing

Determining the sample size is an important step of planning a sample design. Too small a sample may diminish the utility and precision of the results, while too large a sample consumes excess time and effort …

The U.S. Government increasingly uses statistical analysis and data mining to identify fraud and abuse in the healthcare market. A key tool in the Government’s arsenal is RAT-STATS software, which is used to sample and quantify improper claims, which then become the basis for damages and monetary penalties.  As a result, providers, compliance officers and legal professionals must understand the methodologies used by the Government to perform its analysis.  Understanding potential weaknesses in the Government’s analysis is also imperative to a sound defense. This post provides guidance on both fronts…

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.

Consider the concept of statistical inference (i.e. extrapolation).  Following the proper design, selection and analysis of a sample, we can assume the characteristics witnessed in the sample can be reasonably estimated (i.e. inferred) for the total population … extrapolation expert

A variety of cases have addressed the role of statistical sampling in healthcare matters, including litigation before courts, administrative hearings and other matters … Statistical Sampling Case Law