The effects of audits and fines on upcoding in neonatology
| Autor: | Mona Groß, Hendrik Jürges, Daniel Wiesen |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
upcoding
medicine.medical_specialty Behavioral experiment media_common.quotation_subject Audit 03 medical and health sciences Pregnancy health services administration 0502 economics and business Health care ddc:330 medicine Remuneration Birth Weight Humans Neonatology 050207 economics Diagnosis-Related Groups media_common Actuarial science audit policies business.industry audits and fines 030503 health policy & services Health Policy Fraud 05 social sciences Infant Newborn Infant Payment reporting of birth weights Scale (social sciences) Female Business Laboratory experiment 0305 other medical science Delivery of Health Care behavioral experiment |
| Zdroj: | Health Economics. 30:1978-1986 |
| ISSN: | 1099-1050 1057-9230 |
| DOI: | 10.1002/hec.4272 |
| Popis: | 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 consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text