Medicare 'upcoding' accounts for $11 billion in extra costs, investigation finds

Share this article:
Medicare providers increasingly are using higher-paying codes instead of using less complex, lower-paying codes, an investigation has found. This practices, known as “upcoding,” has added $11 billion or more to their fees over 10 years.

Despite the fact that Medicare beneficiaries on the whole are not any older or sicker than previous generations of beneficiaries, physician practices, hospitals and other providers are using higher-paying codes, according to a Center for Public Integrity investigation. In a year-long analysis of Medicare claims, CPI found that upcoding, or “code creep” to be most rampant in doctors office visits, though it happens in nursing homes, hospitals and emergency department visits.

Experts told the Washington Post that the push for electronic health records could inflate the problem. They add that proving a provider has upcoded is difficult. According to the newspaper, the average overcharge per claim is $43. It costs the federal government an average of $30 to $55 to review a claim.

Click here to read the report.
Share this article:

More in News

Rape investigation blocked by nursing home's HIPAA concerns, authorities say ...

Florida authorities say a nursing home is citing privacy laws to impede the investigation of a possible resident rape, according to local news reports.

Jury hands down $14 million negligent care verdict to 'send message' to nursing homes

Jury hands down $14 million negligent care verdict ...

A Massachusetts jury has awarded $14 million to the family of a nursing home resident who died due to a pressure ulcer, dehydration and other conditions linked to negligent care, ...

CCRC executive director salaries hold steady, therapy directors get boost

Continuing care retirement community executive director salaries have barely increased in the past year, while therapy and rehabilitation directors received a boost, a new report shows. The average salary for a therapy and rehab director is currently $95,905.