IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v95y2010i1p41-49.html
   My bibliography  Save this article

The effects of the fraud and abuse enforcement program under the National Health Insurance program in Korea

Author

Listed:
  • Kang, HeeChung
  • Hong, JaeSeok
  • Lee, KwangSoo
  • Kim, Sera

Abstract

Objective To examine the general deterrence effect of the Korean government's fraud and abuse enforcement program on medical clinics in the country. The effects were evaluated by analyzing the association between the fear of penalty from a potential onsite investigation and the costliness index (CI).Method Using a stratified proportional systematic sampling method, 800 out of the 15,443 clinics in Korea that had not had an onsite investigation before June 2007 were selected. Perceived deterrence was measured via face-to-face interviews with the chief doctor of each clinic; these were conducted in July and August 2007. CI was calculated by dividing observed costs by expected costs based on National Health Insurance Claims from January to October 2007.Results Clinics with a high fear of penalty had a significantly lower CI than did other clinics after adjusting for factors related to the provider's perception of onsite investigation, the provider's service experiences, and general characteristics such as provider's sex and age.Conclusion Designing effective fraud and abuse control programs can improve the efficiency of providing services to patients.

Suggested Citation

  • Kang, HeeChung & Hong, JaeSeok & Lee, KwangSoo & Kim, Sera, 2010. "The effects of the fraud and abuse enforcement program under the National Health Insurance program in Korea," Health Policy, Elsevier, vol. 95(1), pages 41-49, April.
    • Handle: RePEc:eee:hepoli:v:95:y:2010:i:1:p:41-49
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(09)00265-6
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Hupert, Nathaniel & Lawthers, Ann G. & Brennan, Troyen A. & Peterson, Lynn M., 1996. "Processing the tort deterrent signal: A qualitative study," Social Science & Medicine, Elsevier, vol. 43(1), pages 1-11, July.
    2. Sverre Grepperud, 2005. "Medical Errors: Getting the Incentives Right," International Journal of Health Economics and Management, Springer, vol. 5(4), pages 307-326, December.
    3. Grepperud Sverre, 2007. "Optimal Prevention when Informal Penalties Matter: The Case of Medical Errors," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 7(1), pages 1-30, August.
    4. Richard A. Derrig & Valerie Zicko, 2002. "Prosecuting Insurance Fraud—A Case Study of the Massachusetts Experience in the 1990s," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 5(2), pages 77-104, September.
    5. Becker, David & Kessler, Daniel & McClellan, Mark, 2005. "Detecting Medicare abuse," Journal of Health Economics, Elsevier, vol. 24(1), pages 189-210, January.
    6. Hyman, David A, 2001. "Health Care Fraud and Abuse: Market Change, Social Norms, and the Trust "Reposed in the Workmen."," The Journal of Legal Studies, University of Chicago Press, vol. 30(2), pages 531-567, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rajeev K. Goel, 2021. "Are health care scams infectious? Empirical evidence on contagion in health care fraud," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 42(1), pages 198-208, January.
    2. Rajeev K. Goel, 2020. "Medical professionals and health care fraud: Do they aid or check abuse?," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 41(4), pages 520-528, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Renee Flasher & Melvin A. Lamboy-Ruiz, 2019. "Impact of Enforcement on Healthcare Billing Fraud: Evidence from the USA," Journal of Business Ethics, Springer, vol. 157(1), pages 217-229, June.
    2. Dionne, Georges, 2012. "The empirical measure of information problems with emphasis on insurance fraud and dynamic data," Working Papers 12-10, HEC Montreal, Canada Research Chair in Risk Management.
    3. Sverre Grepperud, 2005. "Medical Errors: Mandatory Reporting, Voluntary Reporting, or Both?," European Journal of Law and Economics, Springer, vol. 20(1), pages 99-112, July.
    4. Steinbusch, Paul J.M. & Oostenbrink, Jan B. & Zuurbier, Joost J. & Schaepkens, Frans J.M., 2007. "The risk of upcoding in casemix systems: A comparative study," Health Policy, Elsevier, vol. 81(2-3), pages 289-299, May.
    5. Chang-Gyu Yang & Hee-Jun Lee, 2016. "A study on the antecedents of healthcare information protection intention," Information Systems Frontiers, Springer, vol. 18(2), pages 253-263, April.
    6. Heike Hennig‐Schmidt & Hendrik Jürges & Daniel Wiesen, 2019. "Dishonesty in health care practice: A behavioral experiment on upcoding in neonatology," Health Economics, John Wiley & Sons, Ltd., vol. 28(3), pages 319-338, March.
    7. A. James O'Malley & Thomas A. Bubolz & Jonathan S. Skinner, 2021. "The Diffusion of Health Care Fraud: A Network Analysis," NBER Working Papers 28560, National Bureau of Economic Research, Inc.
    8. Katja Müller & Hato Schmeiser & Joël Wagner, 2016. "The impact of auditing strategies on insurers’ profitability," Journal of Risk Finance, Emerald Group Publishing, vol. 17(1), pages 46-79, January.
    9. Barro, Jason R. & Huckman, Robert S. & Kessler, Daniel P., 2006. "The effects of cardiac specialty hospitals on the cost and quality of medical care," Journal of Health Economics, Elsevier, vol. 25(4), pages 702-721, July.
    10. Rajeev K. Goel, 2021. "Are health care scams infectious? Empirical evidence on contagion in health care fraud," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 42(1), pages 198-208, January.
    11. Jason Sutherland & Jeremy Hamm & Jeff Hatcher, 2010. "Adjusting case mix payment amounts for inaccurately reported comorbidity data," Health Care Management Science, Springer, vol. 13(1), pages 65-73, March.
    12. Thuy Nguyen & Victoria Perez, 2020. "Privatizing Plaintiffs: How Medicaid, the False Claims Act, and Decentralized Fraud Detection Affect Public Fraud Enforcement Efforts," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 87(4), pages 1063-1091, December.
    13. Farbmacher, Helmut & Löw, Leander & Spindler, Martin, 2022. "An explainable attention network for fraud detection in claims management," Journal of Econometrics, Elsevier, vol. 228(2), pages 244-258.
    14. Kuhn, Michael & Siciliani, Luigi, 2013. "Manipulation and auditing of public sector contracts," European Journal of Political Economy, Elsevier, vol. 32(C), pages 251-267.
    15. Michael Manocchia & Alyssa Scott & Morgan C. Wang, 2012. "Health consumer susceptibility to medical care fraud: an exploratory analysis," International Journal of Public Policy, Inderscience Enterprises Ltd, vol. 8(1/2/3), pages 136-148.
    16. Jonas Heese, 2017. "The Role of Overbilling in Hospitals’ Earnings Management Decisions," Harvard Business School Working Papers 18-026, Harvard Business School.
    17. Howard, David H. & McCarthy, Ian, 2021. "Deterrence effects of antifraud and abuse enforcement in health care," Journal of Health Economics, Elsevier, vol. 75(C).
    18. Arash Rashidian & Hossein Joudaki & Taryn Vian, 2012. "No Evidence of the Effect of the Interventions to Combat Health Care Fraud and Abuse: A Systematic Review of Literature," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-8, August.
    19. Jiong Gong & R. Preston McAfee & Michael A. Williams, 2016. "Fraud Cycles," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 172(3), pages 544-572, September.
    20. Vijay Iyengar & Keith Hermiz & Ramesh Natarajan, 2014. "Computer-aided auditing of prescription drug claims," Health Care Management Science, Springer, vol. 17(3), pages 203-214, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:95:y:2010:i:1:p:41-49. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.