Yale School of Public Health, New Haven, USA.
Penn State University, State College, USA.
Int J Health Econ Manag. 2023 Sep;23(3):393-409. doi: 10.1007/s10754-023-09357-w. Epub 2023 May 15.
Medicaid Fraud Control Units investigate and prosecute acts of financial fraud and patient abuse within the program. Prior to the expansion of Medicaid under the Affordable Care Act (ACA), federal government MFCU expenditures totaled half a percent of Medicaid expenditures. Following the enrollment of 12 million adults into the Medicaid program under the ACA, expenditures for these units are now less than pre-ACA levels, as a share of program expenses. We use data for states' fraud enforcement efforts in the period 2010-2018 and a difference-in-differences design that exploits states' decision to expand Medicaid under the ACA. States that did expand Medicaid increased their fraud investigations, compared to states that did not expand. Further, civil recoveries and excluded individuals increased after the Medicaid expansion. We find evidence that increases in program scale, in terms of enrollment and utilization, reverted to the mean, facilitating the identification of outlier provider behavior.
医疗补助欺诈控制单位调查和起诉该计划内的财务欺诈和患者虐待行为。在平价医疗法案 (ACA) 扩大医疗补助之前，联邦政府 MFCU 的支出占医疗补助支出的 0.5%。在 ACA 将 1200 万成年人纳入医疗补助计划后，这些单位的支出占项目支出的比例现在低于 ACA 之前的水平。我们使用了 2010 年至 2018 年各州欺诈执法工作的数据和差异中的差异设计，利用各州根据 ACA 扩大医疗补助的决定。与没有扩大医疗补助的州相比，扩大医疗补助的州增加了欺诈调查。此外，在医疗补助扩大后，民事追回和被排除的个人增加。我们有证据表明，在参与和利用方面，计划规模的增加恢复到了平均水平，这有助于发现异常提供者的行为。
