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Full-Text Articles in Insurance

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse Nov 2016

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of ...


Measuring Quality In Diabetes Care: An Expert-Based Statistical Approach, Dimitris Bertsimas, David Czerwinski, Michael Kane Dec 2012

Measuring Quality In Diabetes Care: An Expert-Based Statistical Approach, Dimitris Bertsimas, David Czerwinski, Michael Kane

David Czerwinski

We present a methodology for using health insurance claims data to monitor quality of care. The method uses a statistical model trained on the quality ratings of a medical expert. In a pilot study, the expert rated the quality of care received over the course of two years by 101 diabetes patients. A logistic regression model accurately identified the quality of care for 86% of the patients. Because the model uses data derived from patients’ health insurance claims it can be used to monitor the care being received by a large patient population. One important use of the model is ...


Ranking The Elements Of Swot Matrix With The Approach Of Combining Gray Theory And Dematel Technique, Mahdi Saeedpoor, Abolfazl Kazzazi, Masoud Hadjarian Kashani, Amin Vafadar Nikjoo Feb 2012

Ranking The Elements Of Swot Matrix With The Approach Of Combining Gray Theory And Dematel Technique, Mahdi Saeedpoor, Abolfazl Kazzazi, Masoud Hadjarian Kashani, Amin Vafadar Nikjoo

Amin Vafadarnikjoo

SWOT analysis is one of the most influential tools by which managers can compare the information about the internal and external factors of organization and can use it with respect to the core strategy matrix, and offer a variety of possible strategies. This analysis with all its benefits for the organization does not provide a quantitative basis for identifying the most significant internal and external factors and the relationship between these factors with each other and the business. In other words, this analysis only deals with a few relationships between internal and external factors and ignore effects of other factors ...


Moral Hazards, Crisis, Bail Outs And E-Scads, Judy Johnston, Alexander Kouzmin, Kym Thorne, Stephen Kelly Feb 2011

Moral Hazards, Crisis, Bail Outs And E-Scads, Judy Johnston, Alexander Kouzmin, Kym Thorne, Stephen Kelly

Adjunct Professor Stephen J Kelly

No abstract provided.