Detecting Medicare Abuse
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.
- The Medicare program may be subject to fraud and abuse by providers due to the difficulty of observing the health conditions of and...
Becker, David, Daniel Kessler and Mark McClellan. "Detecting Medicare Abuse," Journal of Health Economics, 2005, v24(1,Jan), 189-210.