Upcoding
Upcoding refers to the billing of certain medical services for more expensive, unwarranted services. For example, you may have symptoms of a cold but get charged as if you have pneumonia. You could have tests done by technicians but coded as being performed by physicians. You could attend group psychotherapy and be charged for an individual session.
Upcoding accounts for 2-3 percent of the overall healthcare provider fraud activities but they can take a big chunk out of the public and private payers’ money.
In one fraudulent upcoding scheme, a podiatrist in Rossville, CA tried to receive reimbursements from Medicare, Medicaid, TRICARE and other private insurers, amounting to more than 2.8 million dollars. He submitted fake evidence that his patients had illnesses and symptoms which required expensive procedures.
RELATED: 7 Unexpected Things Medicare Does Not Cover.
