HIT Consultant October 18, 2023
In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. His crime: performing unnecessary vein ablation procedures on patients, and using incorrect billing codes to receive larger reimbursements. He received $4.5 million in reimbursements from Medicare over a three-year period.
Compared to this example, most instances of “upcoding” and “overcoding” are not as malevolent or expensive. But even an innocent mistake can cause well-intentioned hospitals and health systems to attract attention from federal auditors, and result in stiff penalties for physicians and those who input the wrong billing codes.
Proper medical coding is crucial to accurately reflect the complexity and intensity of any services rendered. Physicians...
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