Wiggin and Dana Files Appellate Amicus Brief on Medicaid Audits

August 7, 2015

Wiggin and Dana's Appellate and Complex Legal Issues Practice Group, in consultation with the firm's Health Care Compliance Group, has filed an amicus brief with the Connecticut Appellate Court on an important issue concerning Medicaid audits of health care providers. The brief addresses the methodology used by the Connecticut Department of Social Services (DSS) to sample a provider's paid claims, determine any overpayments, and then extrapolate from that sample to the universe of claims over a two- or three-year audit period. Extrapolation can magnify the audit results and lead to DSS seeking to recoup a substantial financial penalty.

The amicus brief, filed on behalf of a coalition of seven trade associations and health care providers, provides the Appellate Court with important perspective on DSS's use of extrapolation. The brief explains how the agency's methodology is flawed because it fails to comport with basic statistical principles and federal guidelines. The brief also describes DSS's lack of transparency in failing to disclose to the audited provider the documentation of the sampling and extrapolation methodology used in the audit. "The proper use of extrapolation is critical to any Medicaid audit. Its misuse by auditors not only threatens the fiscal health of Medicaid providers, but is a public health issue if it undermines efforts to expand dental and medical services to the Medicaid population," said C. Scott Litch, Chief Operating Officer and General Counsel of the American Academy of Pediatric Dentistry, which joined the amicus brief. The amicus brief was filed in support of the appeal filed by a Bridgeport dental practice.

The brief is available to view by clicking here.