Date of Conferral

2021

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

James Rohrer

Abstract

Healthcare costs have been rapidly increasing in the United States and consume a significant percentage of the Gross Domestic Product (GDP). A percentage of these costs are attributed to increased incidences of healthcare overpayments to providers. This study examined the impact of these overpayments by provider type, and the underlying reasons which resulted in overpayments from the Medicaid perspective. The theoretical framework used in this study was Ostrom’s institutional analysis and development (IAD) framework. The study used all available data (N = 682) from New York State Medicaid Inspector General final audits of providers for Medicaid overpayments. A chi-square test of association with a Phi and Cramer’s V analysis was used to test for significance. Results of the study were significant and suggest that there is a relationship between provider types and Medicaid overpayment amounts, as well as provider types and error reasons cited for overpayments. Findings indicate a 56.2% prevalence of overpayments in long-term care facilities and 78.9% of dentists failed to meet meaningful use requirements, resulting in the most significant error reason for overpayments. Recommendations for future study include nationwide collection and aggregation of data for overpayment analysis. The study contributes to positive social change by adding to limited body of research regarding overpayments and root causes and allowing providers and healthcare administration professionals to identify and implement best practices for reducing overpayments and alleviating healthcare economic burdens.

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