[Random sampling according to section 17 c KHG--report on the experience of maximal care hospitals in Hesse]

Area of Science:

• Health Economics
• Healthcare Management
• Public Health Policy

Background:

• German hospitals utilize German diagnosis-related groups (G-DRG) for inpatient billing, excluding psychiatric care which uses per-diems.
• The current system involves extensive scrutiny of hospital bills by the Medical Service and systematic random sampling as mandated by the Hospital Financing Law.

Purpose of the Study:

• To review the effectiveness and fairness of the current hospital billing and random sampling process in Germany.
• To identify and address biases within the random sampling methodology for hospital bills.

Main Methods:

• Analysis of the current hospital billing regulations under the German diagnosis-related groups (G-DRG) system.
• Examination of the random sampling procedures for hospital bills as outlined in the Hospital Financing Law (Krankenhausfinanzierungsgesetz, para. 17 c).
• Evaluation of the impact of excluding case-by-case checked bills from the random sample, based on experience in Hessen.

Main Results:

• Thousands of hospital bills undergo scrutiny by the Medical Service.
• Systematic random checks are legally mandated for hospital bills.
• Excluding bills already checked on a case-by-case basis from the random sample introduces avoidable bias.

Conclusions:

• The current practice of excluding pre-checked bills from random sampling is statistically unsound.
• This exclusion undermines the validity of random sampling conclusions in hospital billing audits.
• Regulations regarding random sampling for hospital bills should be revised to eliminate bias and ensure accurate financial oversight.