What Is Upcoding?

Healthcare Fraud lawsuits and settlements have been steadily on the rise and billions of dollars have been recovered. When Medicare or Medicaid fraud is committed, it affects us all. Attorney James Young explains upcoding, a common type of healthcare fraud.


Video Transcript

This is perhaps the easiest fraud to get away with in healthcare. A patient shows up to a provider, gets seen and treated and released.  They receive an EOB or explanation of benefits which correctly lists the date of service and doctor’s examination. 

What they don’t see is that the therapeutic level was billed as a level 3 which required 30 minutes face to face time, when in fact they received a level 1 and only 5 minutes face to face time.  The reimbursed difference can be 5 fold.

If you are a healthcare worker aware of fraud against the government, contact our attorneys for a confidential discussion about your legal rights.