Working Paper: NBER ID: w10677
Authors: David Becker; Daniel Kessler; Mark McClellan
Abstract: This paper identifies which types of patients and hospitals have abusive Medicare billings that are responsive to law enforcement. For a 20 percent random sample of elderly Medicare beneficiaries hospitalized from 1994-98 with one or more of six illnesses that are prone to abuse, we obtain longitudinal claims data linked with Social Security death records, hospital characteristics, and state/year-level anti-fraud enforcement efforts. We show that increased enforcement leads certain types of types of patients and hospitals to have lower billings, without adverse consequences for patients' health outcomes.
Keywords: Medicare; Fraud; Abuse; Enforcement
JEL Codes: I1; K0; K4; L5
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Increased enforcement (K42) | Declines in abusive treatment (J81) |
| Increased enforcement (K42) | Expenditures decline (H59) |
| Increased enforcement (K42) | No adverse health outcomes (I19) |
| Increased enforcement (K42) | Decline in acute expenditures (younger male patients) (H51) |
| Increased enforcement (K42) | Greater decline in acute expenditures (for-profit hospitals) (G32) |
| Increased enforcement (K42) | Greater decline in nonacute expenditures (hospitals owning skilled nursing facilities) (H51) |
| Enforcement-induced reductions in treatment intensity (C22) | Improvements in health outcomes (certain illness groups) (I14) |