Upcoding in Health Care Fraud

Upcoding, also referred to as miscoding, is an improper billing practice where a health care provider submits a claim for reimbursement to a government payor that assigns an inaccurate billing code or diagnosis to a treatment or procedure in an effort to obtain reimbursements in an amount greater than what is owed for the services actually provided. For example, an ambulance service would be “upcoding” if it purposefully submits a claim for reimbursement to Medicare for advanced-level, emergency care when, in reality, it only actually provided care that qualifies as a basic-level service in a non-emergency situation. Upcoding is just one way that providers may try to bend the rules to increase profits.

If you believe you have information about health care fraud in the form of miscoding related to health care services, please contact us for a confidential consultation. Upcoding may form the basis for a False Claims Act violation. Our experienced attorneys are here to help you navigate the process and protect your rights.