Statistical Peer Group Comparisons in Healthcare Overbilling Disputes

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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.

About the Presenter: 

Dr. Panis is a Principal at Advanced Analytical Consulting Group and is an expert in health care, labor issues, demographic issues, econometrics, economic modeling, and statistical sampling. He has extensive experience in predictive modeling and litigation support, including as an economic expert witness in health care, labor, and class action cases.