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24th Annual Institute on Research and Statistics April 15, 2003 CSUS Medi-Cal Recovery

24th Annual Institute on Research and Statistics April 15, 2003 CSUS Medi-Cal Recovery. Kathleen Gallagher, RPS I MA Statistics UC Berkeley 1977 DHS A&I. Medi-Cal. Medi-Cal is the California implementation of the Federal Medicaid Program

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24th Annual Institute on Research and Statistics April 15, 2003 CSUS Medi-Cal Recovery

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  1. 24th Annual Institute on Research and Statistics April 15, 2003 CSUSMedi-Cal Recovery Kathleen Gallagher, RPS I MA Statistics UC Berkeley 1977 DHS A&I

  2. Medi-Cal • Medi-Cal is the California implementation of the Federal Medicaid Program • Medical practitioners get a billing number and bill for services • Audits & Investigations recovers bad billing

  3. Sampling Frame • Medi-Cal commonly uses three years due to a statute of limitations • Sampling unit • I use a beneficiary • SCO uses beneficiary/date of service

  4. From A Book Levy, P. and Lemeshow, S., Sampling of Populations Methods and Applications, 3rd Edition, John Wiley & Sons, 1999. Formula 3.14

  5. Estimated Overpayment • Lower limit of a one-sided 90 percent confidence interval • OneR SQL7.0 Application written by contractor: R Systems

  6. Federal Guideline • Department of Health & Human Services • Centers for Medicare & Medicaid Services (CMS) • Program Memorandum B-02-007 http://cms.hhs.gov/manuals/pm_trans/B02007.pdf • Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims

  7. Sampling • I. E. Consult with a statistical expert • Standard is someone with a master’s degree in statistics or equivalent

  8. Sample Design and Estimation Competition for JSM 2003 • Http://www.amstat.org/education • Graduate, Professional, and Continuing Education • Sample Design and Estimation Competition

  9. Sponsored by • 2003 Joint Program Committee • Cambridge University Press • Duxbury • Ernst and Young • Insightful • Oxbury Press • SAS • Springer-Verlag • SPSS • Statpoint

  10. Eligibility • Students enrolled in graduate program for at least one semester during 2002-2003

  11. Prizes • Based on statistical approach • sample size • sampling error • relative precision • written work • presentation skills • software and books awarded

  12. Design Specifications • Estimate misstated amount • with 90 percent confidence • 10 percent relative precision

  13. Dataset • Simulated population • 51,827 “book values”

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