Economics Seminar（2016-21）

Topic: Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked∗
Speaker: Hanming Fang, University of Pennsylvania
Time: Tuesday, December 27, 14:00-15:30
Place: Room 217, Guanghua Building 2

Abstract:
        Medicare overbilling refers to the phenomenon that providers report more and/or higherintensity service codes than actually delivered to receive higher Medicare reimbursement. We propose a novel and easy-to-implement approach to detect potential overbilling based on the hours worked implied by the service codes 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 (CMS), we first construct estimates for physicians’ hours spent on Medicare Part B FFS beneficiaries. We find that about 2,300 physicians, representing about 3% 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. Interestingly, we also find suggestive evidence that the coding patterns of the flagged physicians seem to be responsive to financial incentives: within code clusters that have different levels of service intensity, they tend to submit more higher-intensity service codes than unflagged physicians; moreover, they are more likely to do so if the marginal revenue from submitting mid- or high-intensity codes is relatively high.

Introduction:

                                 

        Hanming Fang is a Professor at University of Pennsylvania. His research specialties are Public economics and labor economics. His research papers have been published in, among others, American Economic Review, Journal of Law and Economics, American Economic Journal: Microeconomics. He is a leader in the area of Applied Microeconomics in American economics and a chief editor of Journal of Public Economics and International Economic Review.  

Your participation is warmly welcomed!