救护车出租车：监管与诉讼对医疗欺诈的影响

中文摘要

我们研究了「先付后追」诉讼与事前监管在打击医疗欺诈方面的有效性。2003年至2017年间，联邦医疗保险（Medicare）为患者往返透析机构的3750万次定期安排的救护车接送支出了77亿美元，尽管其中许多接送并不符合联邦医疗保险的报销标准。利用基于美国各地监管措施与诉讼交错实施时点的识别策略，我们发现，为救护车费用报销增加事先授权要求，所减少的支出远多于单独提起刑事与民事诉讼所减少的支出。我们没有发现事先授权影响患者健康的证据。

Abstract

We study the effectiveness of pay-and-chase lawsuits and upfront regulations for combating health care fraud. Between 2003 and 2017, Medicare spent $7.7 billion on 37.5 million regularly scheduled ambulance rides for patients traveling to and from dialysis facilities even though many did not satisfy Medicare's criteria for receiving reimbursements. Using an identification strategy based on the staggered timing of regulations and lawsuits across the US, we find that adding a prior authorization requirement for ambulance reimbursements reduced spending much more than pursuing criminal and civil litigation did on their own. We find no evidence that prior authorization affected patients' health.