Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked

• 成果类型: Article
• 署名作者: Fang, Hanming; Gong, Qing
• 署名单位: University of Pennsylvania; University of Pennsylvania; National Bureau of Economic Research
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20160349
• 发表日期: 2017
• 页码: 562-591
• 关键词: PAYMENT DATA; DATA RELEASE; charges

摘要

We propose a novel and easy-to-implement approach to detect potential overbilling based on the hours worked implied by the service codes which physicians submit to Medicare. Using the Medicare Part B Fee-for-Service (FFS) Physician Utilization and Payment Data in 2012 and 2013 released by the Centers for Medicare and Medicaid Services, we construct estimates for physicians' hours spent on Medicare beneficiaries. We find that about 2,300 physicians, representing about 3 percent of those with 20 or more hours of Medicare Part B FFS services, have billed Medicare over 100 hours per week. We consider these implausibly long hours.