Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry
研究美国医院在1988年Medicare规则变化后，未能利用升级编码漏洞的管理团队是否更容易被替换，发现漏洞利用空间显著预测管理层变更，且变更后升级编码增加。
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.