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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.

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Presentation on theme: "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."— Presentation transcript:

1 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

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

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

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

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11 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

12 Sampling I. E. Consult with a statistical expert Standard is someone with a masters degree in statistics or equivalent

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

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

15 Eligibility Students enrolled in graduate program for at least one semester during 2002-2003

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

17 Design Specifications Estimate misstated amount with 90 percent confidence 10 percent relative precision

18 Dataset Simulated population 51,827 book values


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