Health Policy Manag.  2018 Jun;28(2):186-193. 10.4332/KJHPA.2018.28.2.186.

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

• Kim SJ
• Jang SI
• Han KT
• Park EC

• KMID: 2416657
• DOI: http://doi.org/10.4332/KJHPA.2018.28.2.186

Abstract

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.

Keyword

Fraud; Health expenditures; Cost savings; Health policy

MeSH Terms

Cost Savings
Delivery of Health Care*
Fraud*
Health Expenditures*
Health Policy
Insurance, Health
Interrupted Time Series Analysis*
Korea*
National Health Programs