Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked

Author:

Fang Hanming1,Gong Qing2

Affiliation:

1. Department of Economics and Leonard Davis Institute of Health Economics, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, and NBER (e-mail: )

2. Department of Economics and Leonard Davis Institute of Health Economics, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104 (e-mail: )

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. (JEL H51, I13, I18, J22)

Publisher

American Economic Association

Subject

Economics and Econometrics

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