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The U.S. Department of Justice regularly investigates healthcare providers for allegedly fraudulent billing practices resulting in unusually many bills or an unusual prevalence of complex procedures. It purports to demonstrate its allegations through statistical benchmarking on the basis of billing practices of a peer group of providers. Join AACG health economist Stan Panis, PhD, as he draws on his experience with such cases to explain common flaws in peer group definitions and discusses alternative comparisons that may be more appropriate.
This session will cover the following topics:
- DOJ “peer groups” tend to include low-billing providers that are not comparable to the provider under investigation. How can statistical analysis demonstrate biases in DOJ’s comparisons and help identify more appropriate peer groups?
- We illustrate how DOJ’s statistical analysis sometimes draw misleading conclusions and explain how DOJ’s own arguments can be turned around.
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