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An Integrated Decision Making Framework for Medical Audit Sampling

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dc.contributor.author Ekin, Tahir
dc.date.accessioned 2019-01-03T00:23:22Z
dc.date.available 2019-01-03T00:23:22Z
dc.date.issued 2019-01-08
dc.identifier.isbn 978-0-9981331-2-6
dc.identifier.uri http://hdl.handle.net/10125/59848
dc.description.abstract The loss of three to ten percent of annual health care expenditures to fraudulent transactions makes medical audits paramount. In order to handle the size and complexity of medical claims, the use of analytical methods and information technology tools to aid in medical audits is necessary. In general, sampling frameworks are utilized to choose representative claims. However, these are not integrated within audit decision-making procedures. As a novelty, this paper presents an integrated decision-making framework for medical audit sampling. We propose a simple but effective optimization method that uses sampling output and enables auditors address the trade-offs between audit costs and expected overpayment recovery. We use U.S. Medicare Part B claims payment data to demonstrate the framework.
dc.format.extent 8 pages
dc.language.iso eng
dc.relation.ispartof Proceedings of the 52nd Hawaii International Conference on System Sciences
dc.rights Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject Optimization of and the Use of IT for Healthcare Processes
dc.subject Information Technology in Healthcare
dc.subject health care audits, optimization, sampling, information theory, Medicare
dc.title An Integrated Decision Making Framework for Medical Audit Sampling
dc.type Conference Paper
dc.type.dcmi Text
dc.identifier.doi 10.24251/HICSS.2019.498
Appears in Collections: Optimization of and the Use of IT for Healthcare Processes


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