The effects of audits and fines on upcoding in neonatology - Kölner UniversitätsPublikationsServer

Gross, Mona ORCID: 0000-0002-3259-7839, Juerges, Hendrik and Wiesen, Daniel ORCID: 0000-0003-4627-1730 (2021). The effects of audits and fines on upcoding in neonatology. Health Econ., 30 (8). S. 1978 - 1987. HOBOKEN: WILEY. ISSN 1099-1050

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DOI:10.1002/hec.4272

Abstract

Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Gross, Mona	UNSPECIFIED	orcid.org/0000-0002-3259-7839	UNSPECIFIED
Juerges, Hendrik	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wiesen, Daniel	UNSPECIFIED	orcid.org/0000-0003-4627-1730	UNSPECIFIED