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Healthcare
AACG healthcare professionals have assisted counsel in issues ranging from reimbursement disputes to off-label use of pharmaceuticals to demographic projections of health care utilization. Our economists and statisticians are particularly adept at refined benchmarking of client providers to comparable providers around the nation using cost reports, Medicare reimbursement databases (MedPAR, Carrier Statistical Analysis Files), and large-scale surveys collected by agencies of the U.S. Department of Health and Human Services (National Health Interview Survey, Medicare Current Beneficiary Survey). Where information is costly or time-consuming to obtain, we tend to design and adopt a stratified sampling approach to ensure cost-effective results.
Representative Engagements
- Our healthcare experts have assisted counsel in numerous U.S. Department of Justice investigations of hospitals over alleged charge manipulations to boost Medicare Outlier payments. We recalculated what Outlier payments would have been under alternative charge growth scenarios; demonstrated what fraction of above-average Outlier payments were due to patient mix, quality of care, and other facility or patient characteristics; and assessed clients' ability to pay restitution.
- In connection with a hospital expansion dispute, our healthcare professionals served as economic expert to project long-term health care utilization in a hospital's catchment area, accounting for trends in demographics and medical technology.
- Our healthcare professionals served as expert on coding and billing practices of flow cytometry procedures. We documented that the distribution of invoiced markers (antibodies) of a laboratory was consistent with that of comparable laboratories analyzing blood from patients with related ICD-9 codes.
- Our healthcare professionals served as economic expert to assess lifetime lost earnings due to injury in a petition under the Vaccine Act.
- Our healthcare experts designed and implemented a stratified sampling approach to monitor billing and use of durable medical equipment.
- Our healthcare experts implemented a complex stratified sampling approach to measuring billing inaccuracies and Accounts Receivable at a medical provider.
- Our healthcare experts were retained by counsel to help quantify benefits of off-label use of pharmaceuticals.
- Our healthcare experts analyzed workplace injury records to assist counsel refute allegations of racial discrimination in exposure to workplace injury hazards.
- The Centers for Medicare and Medicaid Services (CMS) retained one of our experts to develop a Monte Carlo simulation model of health status and medical expenditures and estimate the financial implications for Medicare and Medicaid of major medical breakthroughs.
- The U.S. Department of Labor retained our health care professionals to document trends in the retiree health insurance liabilities of American companies.
- The Social Security Administration (SSA) retained one of our experts to develop a Monte Carlo simulation model of work and disability status and estimate the financial implications for Social Security's Disability Insurance program of proposed increases in Social Security's early retirement age.
Representative Publications
- Dana Goldman, Baoping Shang, Jayanta Bhattacharya, Alan Garber, Michael Hurd, Geoffrey Joyce, Darius Lakdawalla, Constantijn (Stan) Panis, and Paul Shekelle: "Health and Spending of the Future Elderly: Consequences of Health Trends and Medical Technology." Health Affairs Web Exclusive, September 2005. http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.r5v1.
- Jayanta Bhattacharya, David Cutler, Dana Goldman, Michael Hurd, Geoffrey Joyce, Darius Lakdawalla, Constantijn (Stan) Panis, and Baoping Shang: "Disability Forecasts and Future Medicare Costs." Health Policy Research 2004 (7): 75-94.
- Dana Goldman, Paul Shekelle, Jayanta Bhattacharya, Michael Hurd, Geoffrey Joyce, Darius Lakdawalla, Dawn Matsui, Sydne Newberry, Constantijn (Stan) Panis, Baoping Shang: Health Status and Medical Treatment of the Future Elderly, 2004, RAND TR-169-CMS. http://www.rand.org/publications/TR/TR169.
- Darius Lakdawalla, Dana Goldman, Jay Bhattacharya, Michael Hurd, Geoffrey Joyce, and Constantijn (Stan) Panis: "Forecasting the Nursing Home Population." Medical Care, 41(1): 8-20, January 2003.
- Lee Lillard and Constantijn (Stan) Panis: "Marital Status and Mortality: The Role of Health." August 1996, Demography, 33(3): 313-327.
- Lee Lillard and Constantijn (Stan) Panis: "Child Mortality in Malaysia: Explaining Ethnic Differences and the Recent Decline," 1995, Population Studies 49: 463-479.
- Lee Lillard and Constantijn (Stan) Panis: "Health Inputs and Child Mortality: Malaysia." 1994. Journal of Health Economics, 13: 455-489.
