Discovering healthcare provider behavior patterns through the lens of Medicare excess charge.

ABSTRACT:

Background

The phenomenon of excess charge, where a healthcare service provider bills Medicare beyond the limit allowed for a medical procedure, is quite common in the United States public healthcare system. For example, in 2014, healthcare providers charged an average of 3.27 times (and up to 528 times) the allowable limit for cataract surgery. Previous research contends that such excess charges may be indicative of the actual amount that providers bill to non-Medicare patients and subsequent cost-shifting behavior, where a healthcare provider tries to recoup underpayment by Medicare from privately insured, self-pay, out-of-network, and uninsured patients.

Objectives

The objective of this study is to examine the drivers of a provider's excess charge patterns, especially the

SUBMITTER: Sen S 

PROVIDER: S-EPMC7780410 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature