Statistics and Data Science Seminar
Prof. Klaus Miescke
MSCS, UIC
Statistical Auditing in Medicare and Medicaid Fraud Cases
Abstract: To estimate the total overpayment on a large number of paid claims, government
agencies utilize extrapolation methods that are based on the audit results from
a random sample of these claims. Although there is a variety of approaches that
are reasonable and statistically valid, some play out better than others in the
legal process. For example, the estimator of the total loss must be unbiased by
fairness reasons. Using a biased estimator with a smaller MSE would be
unacceptable. In this talk we describe the entire audit process, including
possible objections from the other side and suggestions on how to respond to
them. The theoretical part of the talk is based on W.G. Cochran (1977), Sampling
Techniques, 3rd ed., Wiley, NY, and the rest on practical experience. It should
be pointed out that it is the loss, not the fraud itself, that can be detected
and estimated
statistically.
Wednesday January 31, 2007 at 4:00 PM in SEO 712