In an unprecedented ruling, a federal judge has declared that officials may use just a statistical sampling of Medicare claims to help prove nursing home company overbilling charges.
Extrapolation is already broadly used by auditors to determine overpayment and damage amounts in False Claims Act cases. This could be the first time it has been greenlighted to help prove wrongdoing.
Judge Harry S. Mattice Jr. said the sheer number of claims could make it “impracticable” to consider them individually. He added that the growth of government programs makes statistical sampling increasingly relevant.
Mattice’s ruling stems from the federal government’s allegations that Life Care Centers of America systematically provided unnecessary therapy to pump up reimbursements. Officials proposed sampling 400 claims from 82 Life Care Centers locations.
Life Care Centers maintains that evidence of specific instances of false claims must be provided. Mattice ruled that the provider can argue in court that “extrapolated evidence” should not be given much weight.
From the November 01, 2014 Issue of McKnight's Long-Term Care News
