A representative sampling plan for auditing health insurance claims

摘要

A stratified sampling plan to audit health insurance claims is offered. Thestratification is by dollar amount of the claim. The plan is representative inthe sense that with high probability for each stratum, the difference in theaverage dollar amount of the claim in the sample and the average dollar amountin the population, is ``small.'' Several notions of ``small'' are presented.The plan then yields a relatively small total sample size with the propertythat the overall average dollar amount in the sample is close to the averagedollar amount in the population. Three different estimators and correspondinglower confidence bounds for over (under) payments are studied.