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RAT-STATS – What Is Rat-Stats?

RAT-STATS and Statistical Estimation of Overpayments


rat-stats statistical samplingRAT-STATS is a free software that is offered by the federal government to assist health care providers with statistical sampling.  Statistical sampling models can be used by health care providers to statistically estimate required overpayments based upon a statistically valid sample.  The RAT-STATS package was developed by the Office of Inspector General to assist providers with random sampling.

The RAT-STATS software suite helps make the random sampling process much easier for providers.  Generally, the RAT-STATS can be used to run a small number of claims in an initial probe audit.  The probe audit will suggest whether problems might exist with a defined, randomly selected parameter of claims.  The sample size estimator function will provide sample sizes for complete audits that can statistically extrapolate findings to estimate overpayments within a range of statistical accuracy.

If used properly, RAT-STATS can assist providers in the performance of defined area audits.  Based on identified problems, RAT-STATS can suggest the scope of further, more statistically reliable audit samples.  Based on the results of more complete audit, RAT-STATS can help estimate overpayments.

RAT-STATS is only a tool to help with statistical projection.  Judgment is required in the identification of risk areas that may require monitoring and auditing.  RAT-STATS can be a useful tool for providers to effectuate their compliance efforts.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
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