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

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  • 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
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    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.

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