Demystifying The Government's Fraud And Abuse Tools For Healthcare

The U.S. Government increasingly uses statistical analysis and data mining to identify fraud and abuse in the healthcare market. A key tool in the government’s arsenal is RAT-STATS software, used to sample and quantify improper claims, which then become the basis for damages and monetary penalties. As a result, healthcare providers, compliance officers and legal professionals must grasp the government’s methodologies for performing this analysis. Understanding potential weaknesses in the government’s analysis is also imperative to a sound defense.

RAT-STATS is a free statistical software package the government offers to assist with statistical analysis. In turn, the government often relies on RAT-STATS when investigating vendors for enforcement or fraud matters. While a user guide exists, the 394-page document and 245-page companion manual are overwhelmingly technical and often dispirit those who most need to understand them. This article will demystify RAT-STATS and clearly articulate what the software can and cannot do.