Zobrazeno 1 - 10
of 144
pro vyhledávání: '"Upcoding"'
Publikováno v:
In Social Science & Medicine February 2025 366
Publikováno v:
Health Economics Review, Vol 14, Iss 1, Pp 1-9 (2024)
Abstract Upcoding in Medicare has been a topic of interest to economists and policy makers for nearly 40 years. While upcoding is generally understood as “billing for services at higher level of complexity than the service actually pro- vided or do
Externí odkaz:
https://doaj.org/article/4819739ae4f54ac1ada3cfa21949faed
Publikováno v:
BMC Medical Informatics and Decision Making, Vol 20, Iss 1, Pp 1-11 (2020)
Abstract Background The healthcare sector is an interesting target for fraudsters. The availability of a great amount of data makes it possible to tackle this issue with the adoption of data mining techniques, making the auditing process more efficie
Externí odkaz:
https://doaj.org/article/23c1cd70b5de43abbae905a0c0e49a54
Autor:
Simon B. Spika, Peter Zweifel
Publikováno v:
Health Economics Review, Vol 9, Iss 1, Pp 1-14 (2019)
Abstract Background With DRG payments, hospitals can game the system by ’upcoding’ true patient’s severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent
Externí odkaz:
https://doaj.org/article/b45bdd2c6f3c45afba14e7a206084e15
Akademický článek
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Akademický článek
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Publikováno v:
Health Economics. 30:1978-1986
Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial conse
Externí odkaz:
https://explore.openaire.eu/search/publication?articleId=doi_dedup___::290e01e7498436786838bfdeab98db5d
https://doi.org/10.1002/hec.4272
https://doi.org/10.1002/hec.4272
Akademický článek
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Publikováno v:
Journal of Health Economics. 59:1-25
Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hosp
Externí odkaz:
https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d89e66bf781c745e01619e74709932ae
https://doi.org/10.1016/j.jhealeco.2018.01.007
https://doi.org/10.1016/j.jhealeco.2018.01.007
Autor:
Paul Damien, Tahir Ekin
Publikováno v:
Healthcare
Volume 9
Issue 10
Healthcare, Vol 9, Iss 1274, p 1274 (2021)
Volume 9
Issue 10
Healthcare, Vol 9, Iss 1274, p 1274 (2021)
Fraudulent billing of health care insurance programs such as Medicare is in the billions of dollars. The extent of such overpayments remains an issue despite the emerging use of analytical methods for fraud detection. This motivates policy makers to
Externí odkaz:
https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3faf4347c755327687372548fa45e9f6
https://pubmed.ncbi.nlm.nih.gov/34682954
https://pubmed.ncbi.nlm.nih.gov/34682954