“…Early studies have already pointed to the unintended consequences of introducing DRG-based payment systems, 4 namely, the attempt by hospitals to increase revenues through fraudulent coding practices (e.g., Barros & Braun, 2017;Carter et al, 1990;Dafny, 2005;Januleviciute, Askildsen, Kaarboe, Siciliani, & Sutton, 2016;Silverman & Skinner, 2004). Shigeoka and Fushimi (2014), Jürges and Köberlein (2015), and Reif, Wichert, and Wuppermann (2018) report evidence for DRG upcoding in neonatal care in Japan and Germany. Common to all these studies is that evidence is provided at an aggregate level.…”