Fierce Healthcare July 30, 2024
Enforcement and physician education are two keys to limiting health plan upcoding, a costly scheme that exploits the Medicare system, health policy experts told Fierce Healthcare.
A recent analysis from The Wall Street Journal found UnitedHealthcare and Humana add diagnoses to members through chart reviews and at-home visits to make them appear sicker, resulting in $50 billion of unnecessary reimbursement from Medicare to care for allegedly sicker patients. Some individuals with diagnoses added to their charts did not receive treatment for those conditions.
Both insurers pushed back against these claims, arguing the calculations were incorrect, but patient upcoding is far from a foreign concept and is not unique to these two insurance companies.
“We all know there’s a lot of...
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