Deterrence Effects of Antifraud and Abuse Enforcement in Health Care /
Howard, David H.
Deterrence Effects of Antifraud and Abuse Enforcement in Health Care / David H. Howard, Ian McCarthy. - Cambridge, Mass. National Bureau of Economic Research 2020. - 1 online resource: illustrations (black and white); - NBER working paper series no. w27900 . - Working Paper Series (National Bureau of Economic Research) no. w27900. .
October 2020.
Estimates of the benefits of antifraud enforcement in health care typically focus on direct monetary damages. Deterrence effects are acknowledged but unquantified. We evaluate the impact of a Department of Justice investigation of hospitals accused of billing Medicare for unnecessary implantable cardiac defibrillator (ICD) procedures on their use. Using 100% inpatient and outpatient procedure data from Florida, we estimate that the investigation caused a 22% decline in unnecessary ICD implantations. The present value of savings nationally over a 10 year period is $2.7 billion, nearly 10 times larger than the $280 million in settlements the Department of Justice recovered from hospitals. The investigation had a large and long-lasting effect on physician behavior, indicating the utility of antifraud enforcement as a tool for reducing wasteful medical care.
System requirements: Adobe [Acrobat] Reader required for PDF files.
Mode of access: World Wide Web.
Deterrence Effects of Antifraud and Abuse Enforcement in Health Care / David H. Howard, Ian McCarthy. - Cambridge, Mass. National Bureau of Economic Research 2020. - 1 online resource: illustrations (black and white); - NBER working paper series no. w27900 . - Working Paper Series (National Bureau of Economic Research) no. w27900. .
October 2020.
Estimates of the benefits of antifraud enforcement in health care typically focus on direct monetary damages. Deterrence effects are acknowledged but unquantified. We evaluate the impact of a Department of Justice investigation of hospitals accused of billing Medicare for unnecessary implantable cardiac defibrillator (ICD) procedures on their use. Using 100% inpatient and outpatient procedure data from Florida, we estimate that the investigation caused a 22% decline in unnecessary ICD implantations. The present value of savings nationally over a 10 year period is $2.7 billion, nearly 10 times larger than the $280 million in settlements the Department of Justice recovered from hospitals. The investigation had a large and long-lasting effect on physician behavior, indicating the utility of antifraud enforcement as a tool for reducing wasteful medical care.
System requirements: Adobe [Acrobat] Reader required for PDF files.
Mode of access: World Wide Web.