Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry

Leemore Dafny and David Dranove

Journal of Law and Economics, 2009, vol. 52, issue 2, 223-250

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.

Date: 2009
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Persistent link: https://EconPapers.repec.org/RePEc:ucp:jlawec:v:52:y:2009:i:2:p:223-250

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