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Session Title: Improper Payment Studies: Government Programs in Housing, Food, and Health Care
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Panel Session 725 to be held in Huntington C on Friday, Nov 4, 2:50 PM to 4:20 PM
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Sponsored by the Government Evaluation TIG
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| Chair(s): |
| Gary Huang, ICF International, ghuang@icfi.com
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| Discussant(s):
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| Daniel Geller, Insight Policy Research, dgeller@insightpolicyresearch.com
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| Abstract:
This 90-minute panel session will introduce improper payment (IP) studies for government programs. To meet the requirements for accountability and financial integrity, federal programs are required by law to conduct studies to measure improper payment due to errors and frauds. IP studies must address design and methodological issues that reflect the dynamics of values and valuing. To determine IP risk, benefit eligibility, and ways to generate IP estimates to inform program improvement, researchers prioritize values and stakeholders' different interests. The panel session will examine methodological issues in designing and implementing IP studies, covering such issues as sample estimates vs. case audits, frauds vs. errors, local service providers vs. program participants, and field data collection vs. administrative data use.
The panel members of three research organizations have years' experience conducting IP studies for programs that provide cash-equivalent benefits to low income populations in meeting basic needs: housing, food, and health care.
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Comprehensive Improper Payment Evaluations for HUD's Assisted-Housing Programs
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| Sophia Zanakos, ICF International, szanakos@icfi.com
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Sophia Zanakos, PhD, Deputy Project Director for the Quality Control for Rental Assistance Subsidy Determinations Studies, will discuss the comprehensive methodologies currently in place to assess improper payments associated with the major assisted-housing programs at HUD. The HUDQC studies utilize a stratified three-stage sampling design to provide nationally representative estimates of 1) the extent of erroneous rental determinations, 2) the extent of billing error associated with the owner-administered program, and 3) the extent of error associated with tenant underreporting of income. The extensive data collection and coordination methodologies will be discussed and include tenant case file abstraction, in-person CAPI interviewing, acquisition of third party information, and data matching with Social Security
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Dynamics of Values and Valuing and Methodological Choices in IP Studies
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| Erika Gordon, ICF International, egordon@icfi.com
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Erika Gordon, PhD, Project Director at ICF, will discuss the comprehensive methodologies currently in place to assess improper payments associated with a USDA program that provides meals to low income children in day care settings. She will present the methodological challenges of identifying improper payments from two distinct perspectives in the program, and contrast how the dynamics of values and valuing shape the methodological choices made in each assessment. She will also contrast the challenges of a quantitative approach with a case study that draws on her experiences using qualitative approaches to assess improper payments. Specific challenges associated with negotiating the objectives, eligibility requirements, stakeholder perspectives as incorporated in study design, data collection and analysis methods will be discussed.
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Fraudulent Claims and the Resulting Improper Payments: Medicaid Administrative Data
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| Gary McQuown, Data and Analytic Solutions Inc, mcquown@dasconsultants.com
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Gary McQuown,Project Manager at DAS for CMS Division of Fraud Research and Detection, will describe efforts by DAS for the Center for Medicare Medicaid Services (CMS) to identity, analyze and document probable fraudulent claims and the resulting improper payments to health care providers. The activity reviewed four years of Medicaid administrative claims data for all US states and territories with a variety of algorithms and statistical processes. Both individual health care providers and related institutions were reviewed with mixed results. The discussion will focus on issues and findings related to the practical and effective analysis of large administrative data from technical, managerial and political perspectives.
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Models and Statistical Techniques for Updating Improper Payment Estimates Generated from National Surveys
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| Richard Mantovani, ICF International, rmantovani@icfi.com
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Richard Mantovani,PhD, Project Director of the USDA's Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) vendor trafficking study, will talk about using administrative data to improve improper payment estimates generated from national surveys. To obtain national estimates for calculating improper payments, many agencies conduct national representative surveys of individuals served and entities paid for providing services. In some cases, these surveys bear close similarities to audits and are overt, in some cases the surveys are covert with the data collector posing as a customer. These surveys are expensive, and some agencies have chosen to do them periodically. At the Food and Nutrition Service, there is a great deal of emphasis to provide updates to these studies using administrative and other available information. However, the administrative data are usually biased, and therefore cannot provide a national picture of improper payments. This discussion will focus on the basic models for updating improper payment estimates, and some of the statistical techniques useful in this Endeavour.
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