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- March 2019
- Article
Evidence of Upcoding in Pay-for-Performance Programs
By: Hamsa Bastani, Joel Goh and Mohsen Bayati
Recent Medicare legislation seeks to improve patient care quality by financially penalizing providers for hospital-acquired infections (HAIs). However, Medicare cannot directly monitor HAI rates and instead relies on providers accurately self-reporting HAIs in claims...
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- December 2016
- Article
Selective Regulator Decoupling and Organizations' Strategic Responses
By: Jonas Heese, Ranjani Krishnan and Frank Moers
Organizations often respond to institutional pressures by symbolically adopting policies and procedures but decoupling them from actual practice. Literature has examined why organizations decouple from regulatory pressures. In this study, we argue that decoupling...
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- 2015
- Article
Regulator Leniency and Mispricing in Beneficent Nonprofits
By: Jonas Heese, Ranjani Krishnan and Frank Moers
We posit that nonprofits that provide a greater supply of unprofitable services (beneficent nonprofits) face lenient regulatory enforcement for mispricing in price-regulated markets. Consequently, beneficent nonprofits exploit such regulatory leniency and exhibit...
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- May 2009
- Article
Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry
By: Leemore S. Dafny and David Dranove