“Upcoding” may sound like a relatively innocuous phrase, and may even sound like a positive thing (who doesn’t want to be “upgraded”?), but Medicare upcoding is a serious and widespread fraudulent offense that costs the federal government billions of dollar a year, profiting Medicare thieves by stealing from senior citizens and American taxpayers. But patients and healthcare workers who have knowledge of upcoding fraud have a way to report this fraud in order to hold greedy individuals and organizations accountable for their illegal actions, while saving taxpayers money and being rewarded with a financial whistleblowing award in the process.
What is Medicare Upcoding?
When doctors and organizations bill the federal government for their Medicare services, they must use an “Evaluation and Management” code (or E&M code) that reflects the complexity and time involved in the medical treatment provided. For example, the treatment involved with evaluating a new patient is generally more thorough and time-intensive than that associated with a regular check-up conducted on an existing patient, and the E&M codes associated with each type of patient treatment should reflect that. The amount of reimbursement paid to the doctor will then rise based on the complexity and length associated with that particular code.
As you might imagine, with upcoding, a doctor will see a patient for one type of treatment and then “upcode” the billing statement to the federal government based on a whole other type of treatment. Upcoding can easily increase a doctor’s salary by tens of thousands of dollars a year, but that new boat or luxury vacation comes out of the pockets of American taxpayers and costs this country billions of dollars a year. In a time of “upselling” and “upsizing,” upcoding may sound like a smart business strategy to increase profits, but upcoding is outright fraud and theft perpetrated on the American public, and any doctor or organization engaging in upcoding should be held responsible.
How to Report Upcoding
If you have information that a doctor or organization is engaging in upcoding, or any other type of Medicare or Medicaid fraud, you can work with an attorney to report the wrongdoing to the federal government through a tip to the Office of the Inspector General, which can result in a $1,000 reward, or through a False Claims Act (FCA) claim which can result in a much higher reward.
At Kreindler & Associates, we represent patients and healthcare professionals like yourself in coming forward to report Medicare fraud. Our experienced healthcare fraud attorneys will work with you every step of the way to determine your appropriate course of action, protect you from retaliation, and collect your much-deserved reward. If you suspect that someone is committing Medicare fraud, contact us today for an evaluation of your allegations.
