Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked

作者：Hanming Fang, Qing Gong · 发表于：American Economic Review · 年份：2017 · DOI：10.1257/aer.20160349 · 被引用次数：44 · 研究领域：Healthcare Policy and Management、Patient Satisfaction in Healthcare、Emergency and Acute Care Studies

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.