Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry

B-Tier
Journal: Journal of Law and Economics
Year: 2009
Volume: 52
Issue: 2
Pages: 223-250

Authors (2)

Leemore Dafny (not in RePEc) David Dranove (Northwestern University)

Score contribution per author:

1.009 = (α=2.02 / 2 authors) × 1.0x B-tier

α: calibrated so average coauthorship-adjusted count equals average raw count

Abstract

This paper investigates whether management teams that fail to exploit regulatory loopholes are vulnerable to replacement. We use the U.S. hospital industry in 1985-96 as a case study. A 1988 change in Medicare rules widened a preexisting loophole in the Medicare payment system, presenting hospitals with an opportunity to increase operating margins by 5 or more percentage points simply by "upcoding" patients to more lucrative codes. We find that having room to upcode is a statistically and economically significant predictor of whether a hospital replaces its management with a new team of for-profit managers. We also find evidence that hospitals that replace their management subsequently upcode more than a sample of similar hospitals whose management did not change. (c) 2009 by The University of Chicago. All rights reserved.

Technical Details

RePEc Handle
repec:ucp:jlawec:v:52:y:2009:i:2:p:223-250
Journal Field
Industrial Organization
Author Count
2
Added to Database
2026-01-25