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Detecting Medicare Abuse

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  • David Becker
  • Daniel Kessler
  • Mark McClellan

Abstract

This paper identifies which types of patients and hospitals have abusive Medicare billings that are responsive to law enforcement. For a 20 percent random sample of elderly Medicare beneficiaries hospitalized from 1994-98 with one or more of six illnesses that are prone to abuse, we obtain longitudinal claims data linked with Social Security death records, hospital characteristics, and state/year-level anti-fraud enforcement efforts. We show that increased enforcement leads certain types of types of patients and hospitals to have lower billings, without adverse consequences for patients' health outcomes.

Suggested Citation

  • David Becker & Daniel Kessler & Mark McClellan, 2004. "Detecting Medicare Abuse," NBER Working Papers 10677, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:10677
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    References listed on IDEAS

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    7. Daniel P. Kessler & Mark B. McClellan, 2002. "The Effects of Hospital Ownership on Medical Productivity," RAND Journal of Economics, The RAND Corporation, vol. 33(3), pages 488-506, Autumn.
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    9. Eduardo Engel & Alexander Galetovic & Claudio Raddatz, 1999. "A Note on Enforcement Spending and Vat Revenues," Documentos de Trabajo 52, Centro de Economía Aplicada, Universidad de Chile.
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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • K0 - Law and Economics - - General

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