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Activity Number:
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333
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Type:
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Contributed
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Date/Time:
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Tuesday, August 8, 2006 : 2:00 PM to 3:50 PM
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Sponsor:
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Section on Health Policy Statistics
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| Abstract - #306056 |
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Title:
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Two-stage Samples and the Minimum Sum Method for Medicare Fraud Investigations
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Author(s):
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Iliana Ignatova*+
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Companies:
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University of South Carolina
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Address:
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322 Catawba Circle, Columbia, SC, 29201,
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Keywords:
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Abstract:
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Random sampling of paid Medicare claims has been legally acceptable for investigating suspicious billing practices by health care providers since 1986. A population of payments made to a given provider during a given time frame is isolated and a sample selected for investigation. Edwards et al. (2005, Health Services & Outcomes Research Methodology) showed that the widely used CLT methods can fail badly. They developed an alternative - the Minimum Sum (MS) method. In this paper the sampling is performed in two stages. In case of little abuse in the first stage the investigation is stopped otherwise a second sample is examined. Based on this strategy a lower confidence bound for total number of payments in error and the corresponding MS lower bound for the total overpayment amount are defined. Criteria for choosing the sampling parameters are considered. Relative efficiencies are studied.
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