Ambulance Taxis: The Impact of Regulation and Litigation on Health Care Fraud

A Denial a Day Keeps the Doctor Away

“…5 Denials may be part of a process to direct treatment decisions towards more appropriate or cost-effective care (Shi, 2022), or to target programs towards more appropriate providers. Preauthorizations may serve a similar role (Brot-Goldberg, Burn, Layton and Vabson, 2022;Eliason, League, Leder-Luis, McDevitt and Roberts, 2021). Importantly, denials may deter fraud, as Crocker and Morgan (1998); Crocker and Tennyson (2002); Dionne, Giuliano and Picard (2009) consider.…”

A Denial a Day Keeps the Doctor Away

“…First, billing hassles could have benefits we do not measure, such as deterring wasteful care or detecting fraud. Future work should investigate these effects in Medicaid, as recent work has done in other contexts in Medicare ( Eliason et al 2021 ;Shi 2022 ;Brot-Goldberg et al 2023 ). Even if there are offsetting benefits, the administrative costs are high and deter physicians from participating in Medicaid.…”

“…Denials may be part of a process to direct treatment decisions towards more appropriate or cost-effective care ( Shi 2022 ), or to target programs toward more appropriate providers. Preauthorizations may serve a similar role ( Eliason et al 2021 ;Brot-Goldberg et al 2023 ). Importantly, denials may deter fraud, as Crocker and Morgan (1998) ; Crocker and Tennyson (2002) ; Dionne, Giuliano, and Picard (2009) ( Bound and Burkhauser 1999 ), food stamps ( Currie and Grogger 2001 ), and student aid ( Dynarski and Scott-Clayton 2006 ).…”

Evaluation of Prior Authorization in Medicare Nonemergent Ambulance Transport

“…Previous studies found that prior authorization was associated with reduced spending for the targeted medication or service, though in some cases this association waned over time . Findings related to the association of prior authorization with total cost of care are mixed, and there is limited evidence on changes in hospitalizations, emergency department visits, time to treatment, patient length of stay, or access to treatment .…”

“…Previous studies found that prior authorization was associated with reduced spending for the targeted medication or service, though in some cases this association waned over time. [1][2][3][4][5][6][7][8][9] Findings related to the association of prior authorization with total cost of care are mixed, and there is limited evidence on changes in hospitalizations, emergency department visits, time to treatment, patient length of stay, or access to treatment. 1,3,7,10 By examining total cost of care and a series of patient outcomes and access to care measures, not just spending for the target service, this study is able to assess the potential for targeted prior authorization programs to improve efficiency in the Medicare program without a change in beneficiaries' health.…”