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Chapter 12 The Economics of Information Learning Objectives © 2022 by McGraw-Hill Education. All Rights Reserved. 12-‹#› Identify Identify strategies to manage risk and uncertainty, including diversification and optimal search strategies. Calculate Calculate the profit-maximizing output and price in an environment of uncertainty. Explain Explain why asymmetric information about “hidden actions” or “hidden characteristics” can lead to moral hazard and adverse selection and identify strategies for mitigating these potential problems. Explain Explain how differing auction rules and information structures impact the incentives in auctions and determine the optimal bidding strategies in a variety of auctions with independent or correlated values. A variable that measures the outcome of an uncertain event is called a random variable. Probabilities can be attached to different values of a random variable that denote the chance that a value occurs. Information about uncertain outcomes can be summarized by the mean (or, expected value) and variance of a random variable. © 2022 by McGraw-Hill Education. All Rights Reserved. Measuring Uncertain Outcomes 12-‹#› 3 The mean (or expected value) of a random variable is the sum of the probabilities that different outcomes will occur multiplied by the resulting payoffs. If denote the possible outcomes of the random variable and the corresponding probabilities of the outcomes, then the expected value of is: , where . The mean does not provide information about the risk associated with the random variable. © 2022 by McGraw-Hill Education. All Rights Reserved. Measuring Uncertain Outcomes: Mean 12-‹#› 4 The variance of a random variable is the sum of the probabilities that different outcomes will occur multiplied by the squared deviation from the mean of the resulting payoffs. If denote the possible outcomes of the random variable, their corresponding probabilities are , and the expected value of is , then the variance of is: The variance is a common measure of risk. The standard deviation is the positive square root of the variance: . © 2022 by McGraw-Hill Education. All Rights Reserved. Measuring Uncertain Outcomes: Variance and Standard Deviation 12-‹#› 5 Attitudes toward risk differ among consumers. A risk-averse consumer prefers a sure amount of to a risky prospect with an expected value of . A risk-loving consumer prefers a risky prospect with an expected value of to a sure amount of . A risk-neutral consumer is indifferent between a risky prospect with an expected value of and a sure amount of . © 2022 by McGraw-Hill Education. All Rights Reserved. Risk Aversion 12-‹#› 6 Risk analysis can used to examine situations where consumers are uncertain about product quality. Consider a consumer who regularly uses Brand X. If a new product enters the market, Brand Y, under what conditions will the consumer be willing to try the new product? Issues to ove ...

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With growing awareness of the climate crisis generally comes a desire for more eco-friendly products. Certainly, in my family, we're keen to understand the impact of what we buy and are regularly asking questions such as, "Is this fair trade?" and "Was this farmed sustainably?" We're trying to be conscious consumers, in other words, seeking to understand the wider impact of our purchases and, wherever possible, choosing more sustainable, responsible alternatives. And as this major business trend shows, we’re not alone.

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Chapter 12 Repayments and Disclosures Learning Objectives Circumstances when disclosure and repayment might make sense Government agencies for disclosures Legal bases for duty to disclose and repay Benefits and disadvantages of self-disclosure Importance of advice of legal counsel Process for conducting a self-disclosure Differences between OIG SDP and Stark SRDP Introduction Self-disclosure may be indicated by a report of non-compliance, a routine internal audit, or the discovery of a billing error in the normal course of business. Self-disclosure may be directed to the CMS, a CMS intermediary or carrier, the OIG, the DOJ, the FBI, a state Medicaid Fraud Control Unit, or a state agency responsible for provider licensing. Legal Bases for Repayment and Disclosure Patient Protection and Affordable Care Act (PPACA) False Claims Act (FCA) Stark Physician Self-referral Law Anti-Kickback Statute (AKS) Health Insurance Portability and Accountability Act (HIPAA) Patient Protection and Affordable Care Act (PPACA) Overpayment reported and returned within 60 days of identification. Patient co-payments returned as well. Disclosures and repayments submitted to Medicare “affiliated carrier”. False Claims Act (FCA) Reduce treble damages for false claim to double damages by disclosing violation within 30 days of learning about it. “Reverse false claim”: a violation for a person or organization to make a fraudulent statement in order to avoid or reduce an “obligation” to make a payment to the federal government. Stark Physician Self-referral Law The Self-Referral Disclosure Protocol (SRDP) was created in 2010 and applies only to the Stark Physician Self-referral Law. It is used to resolve overpayment liability exposure resulting from a violation. Detailed information about the violation and the entity’s compliance program is submitted to CMS. In response, the CMS “may” reduce any overpayments owed due to the violation. 7 Anti-Kickback Statute (AKS) In 1998, the OIG issued a Self-Disclosure Protocol (SDP) to be used to report overpayments connected with the AKS or both the AKS and the Self-Referral Law. Overpayments related to the Self-Referral Law alone are handled through the SRDP. Offers opportunity to reduce the severe penalties associated with AKS violations. Health Insurance Portability and Accountability Act (HIPAA) In the landmark ETHC case, federal government brought criminal charges for failure to refund overpayments related to HIPAA. Case involved overpayments from private payors and individual patients, akong with Medicare and Medicaid. Benefits of Self-Disclosure More congenial, less adversarial relationship with the enforcement officials More influence over the conduct of the government investigation Reduced likelihood of subpoenas or search warrants Reduced penalties for a FCA violation Less likely that government will prosecute Less onerous terms of any settlement Disadvantages of Self-Disclosure Violation incide ...

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Thanks to the technological convergence which the Internet of Things is, a lot of data is being generated by people and objects. But Big Data is valuable only as long as it is actionable. This amount of available data can and will have a strong impact on every industry in the next few years, providing new opportunities to improve business intelligence and make smarter decisions. Business insider estimates that there will be 18 billion connected devices by 2018. While considering IoT on a consumer level, Strategy Analytics claims we will have 4,3 smart devices per person on the planet by 2020. Such a horizontal distribution of the internet of things allows insurance companies to estabilish a new dialogue with their customers. On the other hand, it will allow them to design tailor made solutions based on internet of things based analytics.

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With support by the CII, Marketforce launched this special report providing a snapshot of the challenges and opportunities the industry is facing - and how to prepared it is to meet them. Based on responses from over 1000 senior insurers, in this report you will find dedicated chapters on digital, analytics, operations, claims, fraud and more. Would you like to meet like-minded insurers? On November 7th, 8th and 9th we're holding our 16th annual The Future of General Insurance conference. Find out more about the event here: http://bit.ly/1TKDIgQ

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