Between 2003 and 2017, Medicare spent $7.7 billion on non-emergency rides for dialysis patients. Some of those rides, however, didn't meet the program's standard of medical necessity. In this episode of Research Reverb, Gies Business economist Riley League explains "medical necessity fraud" and his research comparing two very different approaches to combatting that fraud: "pay and chase" litigation and prior authorization. His team's findings illustrate that prior authorization regulation can dramatically reduce fraud without any impact on patients - and that a little upstream friction can actually help keep assistance available for those who need it.
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