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Do Fraud Investigations Impact Healthcare Expenditures of Medical Institutions?: An Interrupted Time Series Analysis of Healthcare Costs in Korea

 Seung Ju Kim  ;  Sung-In Jang  ;  Kyu-Tae Han  ;  Eun-Cheol Park 
 Korean Journal of Health Policy and Administration (보건행정학회지), Vol.28(2) : 186-193, 2018 
Journal Title
 Korean Journal of Health Policy and Administration (보건행정학회지) 
Issue Date
Cost Savings ; Delivery of Health Care* ; Fraud* ; Health Expenditures* ; Health Policy ; Insurance, Health ; Interrupted Time Series Analysis* ; Korea* ; National Health Programs
Cost savings ; Fraud ; Health expenditures ; Health policy
BACKGROUND: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. METHODS: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. RESULTS: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (−1.40%, p < 0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, −0.33%; non-target organizations of same region, −0.19%; non-target organizations of other regions, −0.17%). CONCLUSION: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Jang, Sung In(장성인) ORCID logo https://orcid.org/0000-0002-0760-2878
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