Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed.

中文翻译：

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审计和罚款对新生儿科升级的影响

升级是医疗保健中常见的欺诈类型。然而，如何设计审计策略以应对升级的问题还不是很清楚。我们提供有关具有不同概率和财务后果的随机审计影响的因果证据。使用受控实验室实验，我们模仿产科工作人员的决策情况来报告新生儿的出生体重。受试者在实验中的报酬取决于他们报告的出生体重，并遵循德国非线性诊断相关的新生儿护理组报酬。我们的结果表明，低检测概率的审计只会减少欺诈性出生体重报告，同时伴随欺诈报告的罚款。对于有罚款的审计政策，增加审计概率只会有效增强诚实报告，当从可检测到收益较低的不可检测升级不可行时。讨论了对审计策略的影响。