Journal of Commerce and Accounting Research

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Determination of Sample Size for Auditing Medical Insurance Claims


Affiliations
1 The University of Burdwan, West Bengal, India; and Assistant Professor in Commerce, Rabindra Mahavidyalaya, Hooghly, W.B., India
2 Department of Commerce, The University of Burdwan, West Bengal., India
     

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In the case of sample audit of the medical insurance claims, a complex as well as serious problem arises with the reality of the population characteristics of population error. The present study examines whether sample claims (those the auditors consider by nature or classification) is random or not. The paper puts forward that the sample size varies with respect to identification of different stages of audit by the Trainee, Processor, and Sr. Processor. For the first place that is, a sample audit by the Trainee, a firm's dependence on sample audit procedure should be taken into an utmost care. The study determines sample size econometrically through the application of the concept in Poisson distribution. Apart from these, the study suggests some ad-hoc population ranges and sample size against these ranges.

Keywords

Sample Audit, Sample Size, Population Error, And Medical Insurance Claims
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  • Adcock, C.J., (1992). Bayesian Approaches to the Determination of Sample Sizes for Binomial and Multinomial Sampling-Some Comments on the Paper by Pham-Gia and Turkkan, The Statistician , 41 (4), 99-404.

  • Adcock, C.J. (1997). Sample size determination: A review. The Statistician, 46 (2), 261–283.

  • Gelman, A., (2008). Objections to Bayesian statistics, Bayesian Analysis, 3(3), 445-450, DOI:10.1214/08-BA318.

  • Israle, G. D., (1992). Determining Sample Size, Fact Sheet PEOD-6, November, 1992; Florida Co-operative Extension Service, University of Florida.

  • http://www.soc.uoc.gr/socmedia/papageo/metaptyxiakoi/ sample_size/samplesize1.pdf.

  • Kothari, C. R., (2004). Research Methodology, Methods & Techniques, New Age International (P) Limited, Publishers (formerly Willy Eastern Limited), New Delhi, 2nd Edition.

  • Kruschke, J. K., (2010). What to believe: Bayesian methods for data analysis. Trends in Cognitive Science, 14 (7), 293-300

  • Pathak, J., Vidyarthi, N., & Summers, S. L., (2005). A fuzzy-based algorithm for auditors to detect elements of fraud in settled insurance claims. Managerial Auditing Journal, 20 (6), 632-644


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  • Determination of Sample Size for Auditing Medical Insurance Claims

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Authors

Paritosh Chandra Sinha
The University of Burdwan, West Bengal, India; and Assistant Professor in Commerce, Rabindra Mahavidyalaya, Hooghly, W.B., India
Santanu Kumar Ghosh
Department of Commerce, The University of Burdwan, West Bengal., India

Abstract


In the case of sample audit of the medical insurance claims, a complex as well as serious problem arises with the reality of the population characteristics of population error. The present study examines whether sample claims (those the auditors consider by nature or classification) is random or not. The paper puts forward that the sample size varies with respect to identification of different stages of audit by the Trainee, Processor, and Sr. Processor. For the first place that is, a sample audit by the Trainee, a firm's dependence on sample audit procedure should be taken into an utmost care. The study determines sample size econometrically through the application of the concept in Poisson distribution. Apart from these, the study suggests some ad-hoc population ranges and sample size against these ranges.

Keywords


Sample Audit, Sample Size, Population Error, And Medical Insurance Claims

References