This paper examines the tradeoffs of monitoring for wasteful public spending. By penalizing unnecessary spending, monitoring improves the quality of public expenditure and incentivizes firms to invest in compliance technology. I study a large Medicare program that monitored for unnecessary health care spending and consider its effect on government savings, provider behavior, and patient health. Every dollar Medicare spent on monitoring generated ${\$}$24–29 in government savings. The majority of savings stem from the deterrence of future care, rather than reclaimed payments from prior care. I do not find evidence that the health of the marginal patient is harmed, indicating that monitoring primarily deters low-value care. Monitoring does increase provider administrative costs, but these costs are mostly incurred up-front and include investments in technology to assess the medical necessity of care.

中文翻译：

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废物监测：医疗保险审计的证据


本文探讨了监督浪费性公共支出的权衡。通过惩罚不必要的支出，监控可以提高公共支出的质量，并激励企业投资于合规技术。我研究了一个大型医疗保险计划，该计划监控不必要的医疗保健支出，并考虑其对政府储蓄、提供者行为和患者健康的影响。医疗保险用于监控的每一美元都会为政府节省 ${\$}$24-29 美元。大部分节省源于未来护理的威慑，而不是从先前护理中收回的付款。我没有发现边缘患者的健康受到损害的证据，这表明监测主要阻止低价值护理。监控确实会增加提供者的管理成本，但这些成本大部分是预先产生的，包括评估护理的医疗必要性的技术投资。