Dishonesty in health care practice: A behavioral experiment on upcoding in neonatology.
audits and fines
dishonesty
medically framed experiment
neonatology
reporting of birth weights
Journal
Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
13
06
2018
revised:
02
10
2018
accepted:
23
10
2018
pubmed:
15
12
2018
medline:
11
6
2020
entrez:
15
12
2018
Statut:
ppublish
Résumé
Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context. Prevalent dishonest behavior declines significantly when audits and fines are introduced. The effect is driven by a reduction in upcoding when being detectable. Yet upcoding increases when not being detectable as fraudulent. We find evidence that individual characteristics (gender, medical background, and integrity) are related to dishonest behavior. Policy implications are discussed.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
319-338Informations de copyright
© 2018 John Wiley & Sons, Ltd.