Ambulance Taxis: The Impact of Regulation and Litigation on Health Care Fraud

48 Pages Posted: 23 Nov 2021 Last revised: 30 Jan 2025

See all articles by Paul Eliason

Paul Eliason

Brigham Young University

Riley League

Duke University

Jetson Leder-Luis

Boston University

Ryan C. McDevitt

Fuqua Graduate School of Business - Duke University; Duke Innovation & Entrepreneurship Initiative

James W. Roberts

Duke University

Date Written: November 2021

Abstract

We study the relative effectiveness of administrative regulations, criminal enforcement, and civil lawsuits for combatting health care fraud. Between 2003 and 2017, Medicare spent $7.7 billion on 37.5 million regularly scheduled, non-emergency ambulance rides for patients traveling to and from dialysis facilities, with dozens of lawsuits alleging that Medicare reimbursed rides for patients who did not meet the requirements for receiving one. Using a novel data set and an identification strategy based on the staggered timing of regulations and lawsuits across the United States, we find that a regulation requiring prior authorization for ambulance reimbursements reduced spending much more than criminal and civil lawsuits did. Despite the sharp drop in both ambulance transports and the companies that provide them following prior authorization, patients’ health outcomes did not change, indicating that most rides were not medically necessary. Our results suggest that administrative actions have a much larger impact than targeted criminal enforcement, providing novel evidence that regulations may be more cost-effective than ex post ligation for preventing health care fraud.

Suggested Citation

Eliason, Paul and League, Riley and Leder-Luis, Jetson and McDevitt, Ryan C. and Roberts, James W., Ambulance Taxis: The Impact of Regulation and Litigation on Health Care Fraud (November 2021). NBER Working Paper No. w29491, Available at SSRN: https://ssrn.com/abstract=3968714

Paul Eliason (Contact Author)

Brigham Young University ( email )

Provo, UT 84602
United States

Riley League

Duke University ( email )

Jetson Leder-Luis

Boston University ( email )

595 Commonwealth Avenue
Boston, MA 02215
United States

Ryan C. McDevitt

Fuqua Graduate School of Business - Duke University ( email )

100 Fuqua Dr
Durham, NC 27708
United States

HOME PAGE: http://www.ryanmcdevitt.com

Duke Innovation & Entrepreneurship Initiative ( email )

215 Morris St., Suite 300
Durham, NC 27701
United States

James W. Roberts

Duke University ( email )

100 Fuqua Drive
Durham, NC 27708-0204
United States

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