Medicine and Health Sciences Commons^™

Exploration Of Data Science Toolbox And Predictive Models To Detect And Prevent Medicare Fraud, Waste, And Abuse, Benjamin P. Goodwin, Adam Canton, Babatunde Olanipekun

SMU Data Science Review

The Federal Department of Health and Human Services spends approximately $830 Billion annually on Medicare of which an estimated $30 to $110 billion is some form of fraud, waste, or abuse (FWA). Despite the Federal Government’s ongoing auditing efforts, fraud, waste, and abuse is rampant and requires modern machine learning approaches to generalize and detect such patterns. New and novel machine learning algorithms offer hope to help detect fraud, waste, and abuse. The existence of publicly accessible datasets complied by The Centers for Medicare & Medicaid Services (CMS) contain vast quantities of structured data. This data, coupled with industry standardized …

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

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The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Healthcare Utilization & Health Behaviors Among Older Adults: The Role Of Insurance, Jennifer Rose Geiger

LSU Doctoral Dissertations

As the population of older adults in the U.S. continues its exponential growth, so too will the need for high-quality health and preventive services. Despite the widely acknowledged need for proactive solutions to the coming public health challenges for this rapidly expanding age cohort, healthcare providers and social work practitioners continue to lack the proper education training to serve the needs of older adults. Furthermore, these allied health professionals also frequently engage in ageist behaviors across care settings that also often employ institutionally ageist policies and procedures. As a result, older adults may be particularly at risk of negative health …

Residential Settings And Healthcare Use Of The Rural "Oldest-Old" Medicare Population, Nathan Paluso Mph, Zachariah T. Croll Mph, Deborah Thayer Mba, Jean A. Talbot Phd, Mph, Andrew F. Coburn Phd

Long Term Services and Supports

The aging of the baby boom generation is projected to dramatically increase the population aged 65 and older in the coming decades. In particular, those aged 85 and older (the ‘oldest old’) are expanding at a faster rate than any other age group and by 2050 are expected to make up 4.5 percent of the population, compared to 1.9 percent in 2012. Faster growth in the percentage of older people (65+) in rural than in urban areas is likely to challenge the healthcare and long term services and supports (LTSS) capacity in many rural communities.

This study used Medicare Current …

Hospice Utilization Of Medicare Beneficiaries In Hawai‘I Compared To Other States, Deborah Taira, Merle Kataoka-Yahiro, Angela Sy

Asian/Pacific Island Nursing Journal

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian …

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Healing The Health Care System: Summaries From The Department Of Health Policy Summer Seminar, David B. Nash, Nora Dowd Eisenhower, Rosemarie Greco, Deborah C. Meiris

College of Population Health Faculty Papers

Editorial Introduction:
The disease management field continues to evolve. The range of chronic diseases treated has expanded to include such conditions as obesity and pain management, and the care continuum now encompasses wellness, prevention, and population health. One population that is an ideal candidate for our collective efforts is that of older adults. Global and national population projections reveal the impending staggering increase in the age 65+ cohort, which will cause a sharp increase in the demand for health care and other services due to such age-related issues as multiple chronic conditions, falls, and depression.

To begin to address these …