Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked
American Economic Review
vol. 107,
no. 2, February 2017
(pp. 562-91)
Abstract
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.Citation
Fang, Hanming, and Qing Gong. 2017. "Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked." American Economic Review, 107 (2): 562-91. DOI: 10.1257/aer.20160349Additional Materials
JEL Classification
- H51 National Government Expenditures and Health
- I13 Health Insurance, Public and Private
- I18 Health: Government Policy; Regulation; Public Health
- J22 Time Allocation and Labor Supply