In the past when your PHO was audited the Audit Team would select (or you would nominate) between 1 and 5 practices to be audited and 100 people in each of those practices would be examined in detail. In particular evidence of enrolment would be required to be shown.
This sampling process has been changed and the Audit Team will now audit ALL of your practices. At each practice they will examine enough patients to make the sample statistically significant. The size of the practice will determine how many will be examined - the number will be between 300 and 400 (See instructions below to get an estimate of the sample size for your practices.)
After the Audit Team has examined your records they will make a determination of how many patients in the sample were "incorrectly" funded.
The most common reason they will make this determination will be because you are unable to produce a signed enrolment form for the patients.
They will then calculate the total amount of funding that the PHO (and therefore practice) "incorrectly" received for those patients.
At this point the PHO and practice will be given an opportunity to comment.
Once that process is complete Audit and Compliance will divide the amount of money owing by the sample size and then multiply by the practice funded population
to get an estimate of the total for the whole practice.
Practice has 5000 patients
Sample is 357 patients
The practice can't find enrolment forms for 25 of those patients
That represents around $1000 of funding to the practice and a further $400 for the PHO
The extrapolation equation is ($1400/357)*5000 (funding total divided by sample * patients)
So the total that Audit and Compliance will recommend that your DHB claims back will be $19,607