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Publications

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  • All HBS Web  (8)
    • Faculty Publications  (4)

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    • All HBS Web  (8)
      • Faculty Publications  (4)

      Upcoding Remove Upcoding →

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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...  View Details
      Keywords: Medical Coding; Health Policy; Healthcare-acquired Conditions; Medicare; Health Care and Treatment; Policy; Performance Improvement; Quality; Measurement and Metrics; Government Legislation
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      Bastani, Hamsa, Joel Goh, and Mohsen Bayati. "Evidence of Upcoding in Pay-for-Performance Programs." Management Science 65, no. 3 (March 2019): 1042–1060. (2015 INFORMS Health Applications Society best student (H. Bastani) paper award.)
      • 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...  View Details
      Keywords: Regulator Leniency; Beneficence; Mispricing; Upcoding; Nonprofit Organizations; Health Care and Treatment; Revenue; Health Industry
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      Heese, Jonas, Ranjani Krishnan, and Frank Moers. "Selective Regulator Decoupling and Organizations' Strategic Responses." Academy of Management Journal 59, no. 6 (December 2016). (Selected for Best Paper Proceedings of the 2015 Academy of Management Annual Meeting. Winner of the Healthcare Management Division of the Academy of Management 2015 Best Paper Award.)
      • 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...  View Details
      Keywords: Nonprofit Organizations; Business Earnings; Fairness; Governance Compliance
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      Heese, Jonas, Ranjani Krishnan, and Frank Moers. "Regulator Leniency and Mispricing in Beneficent Nonprofits." Art. 11998. Academy of Management Proceedings (2015).
      • May 2009
      • Article

      Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry

      By: Leemore S. Dafny and David Dranove
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      Dafny, Leemore S., and David Dranove. "Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry." Journal of Law & Economics 52, no. 2 (May 2009): 223–250.
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