Deterrence Effects of Antifraud and Abuse Enforcement in Health Care / David H. Howard, Ian McCarthy.

Format:

Book

Author/Creator:

Howard, David H.

Contributor:

National Bureau of Economic Research.

McCarthy, Ian.

Series:

Working Paper Series (National Bureau of Economic Research) no. w27900.

NBER working paper series no. w27900

Language:

English

Physical Description:

1 online resource: illustrations (black and white);

Place of Publication:

Cambridge, Mass. National Bureau of Economic Research 2020.

Summary:

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.

Notes:

Print version record

October 2020.