Centers for Medicare and Medicaid Services (U.S.), Delivery of Health Care, Economics, Fraud, Health Expenditures
Conditions
Brief summary
Fraud and waste is estimated to cost the American health care system nearly $200 billion each year, and the public Medicare and Medicaid programs about $60 billion each year. This study will evaluate a new method for fighting fraud: mailing informative letters to outlier providers to notify them of their aberrant behavior. These letters are targeted at high prescribers of schedule II controlled substances in Medicare Part D. The investigators will look at the effects of these letters on the behavior of providers and their patients. These effects are of substantial policy interest as they suggest how to best design anti-fraud policies. They are also of academic interest, shedding light on the behavior of physicians and their patients.
Interventions
OTHERInformative letter
The intervention is a letter that describes the Schedule II prescribing activity of the individual in comparison to a peer group of similar prescribers. It highlights the fact that the prescriber's activity is highly unlike her peers.
Sponsors
Centers for Medicare and Medicaid Services
General Services Administration (GSA)
Abdul Latif Jameel Poverty Action Lab
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Outlier with respect to the count of schedule II prescription drug events relative to peer group of prescribers in two of the three years 2011, 2012, and 2013 * Outlier with respect to the 30-day equivalent prescriptions of schedule II substances relative to peer group of prescribers in two of the three years 2011, 2012, and 2013
Exclusion criteria
\- Deceased
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 30-day Equivalent Prescribing of Schedule II Controlled Substances | 3 months | The prescribing of schedule II controlled substances over the 3 months following the initial sending of the letters. Prescribing is defined as the total days supply of schedule II controlled substances attributed to the prescriber, expressed in 30-day equivalents i.e. divided by 30. |
Secondary
| Measure | Time frame |
|---|---|
| 30-day Equivalent Prescribing of Schedule II Controlled Substances | 1 month |
Participant flow
Recruitment details
There was no recruitment in the traditional sense. High prescribers of Schedule II controlled substances were identified in Medicare administrative data using a Tukey outlier method.
Pre-assignment details
Seven of the identified outliers had died by the time of the study and were excluded from the intervention and later analysis.
Participants by arm
| Arm | Count |
|---|---|
| No Informative Letter This is the control arm and it involves no contact with the prescriber | 0 |
| Informative Letter This is the treatment arm; prescribers in this arm receive an informative letter (called a comparative billing report or peer activity report)
Informative letter: The intervention is a letter that describes the Schedule II prescribing activity of the individual in comparison to a peer group of similar prescribers. It highlights the fact that the prescriber's activity is highly unlike her peers. | 0 |
| Total | 0 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Deceased (excluded from intervention and analysis) | 5 | 2 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 758 | 0 / 760 |
| serious Total, serious adverse events | 0 / 758 | 0 / 760 |
Outcome results
Primary
30-day Equivalent Prescribing of Schedule II Controlled Substances
The prescribing of schedule II controlled substances over the 3 months following the initial sending of the letters. Prescribing is defined as the total days supply of schedule II controlled substances attributed to the prescriber, expressed in 30-day equivalents i.e. divided by 30.
Time frame: 3 months
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| No Informative Letter | 30-day Equivalent Prescribing of Schedule II Controlled Substances | 461.1 30-day equivalent prescription fills | Standard Deviation 443.9 |
| Informative Letter | 30-day Equivalent Prescribing of Schedule II Controlled Substances | 450.0 30-day equivalent prescription fills | Standard Deviation 450.9 |
95% CI: [-6.35, 13.4]
Secondary
30-day Equivalent Prescribing of Schedule II Controlled Substances
Time frame: 6 months
Population: Outcome measure not collected for study
Secondary
30-day Equivalent Prescribing of Schedule II Controlled Substances
Time frame: 9 months
Population: Outcome measure not collected for study
Secondary
30-day Equivalent Prescribing of Schedule II Controlled Substances
Time frame: 1 month
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| No Informative Letter | 30-day Equivalent Prescribing of Schedule II Controlled Substances | 155.5 30-day equivalent prescription fills | Standard Deviation 148.8 |
| Informative Letter | 30-day Equivalent Prescribing of Schedule II Controlled Substances | 151.1 30-day equivalent prescription fills | Standard Deviation 150.4 |
95% CI: [-3.68, 2.1]
Secondary
30-day Equivalent Prescribing of Schedule II Controlled Substances
Time frame: 1 year
Population: Outcome measure not collected for study