Maximizing Restitution for Erroneous Medical Payments When Auditing Samples

Karl W. Heiner and Owen Whitby
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Karl W. Heiner: School of Management, Rensselaer Polytechnic Institute, Troy, New York 12181
Owen Whitby: SwissRe Holding (N.A.) Inc., New York, New York 10017

Interfaces, 1980, vol. 10, issue 4, 46-54

Abstract: In auditing of paid Medicaid claims, estimates of payments erroneously paid to providers are frequently based on statistical samples. When such procedures are used, hearing officers are often inclined to use the lower end of an interval estimate to determine restitution by a provider. In this paper, the advantages of estimating from large samples are weighed against the larger costs involved. A procedure for choosing a sample size that would maximize net recovery is proposed.

Keywords: statistics: sampling; health care (search for similar items in EconPapers)
Date: 1980
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Persistent link: https://EconPapers.repec.org/RePEc:inm:orinte:v:10:y:1980:i:4:p:46-54

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