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The Trouble With Upcoding Extends Far Beyond Ethics | MedPage Today

This practice seemed harmless enough. However, I later learned that upcoding is responsible for $12-25 billion in overpayments opens in a new tab or window to Medicare Advantage insurers each year, enough to provide free vision and hearing care to every senior over age 65. I was involved in a practice that, at best, was billing in a way that increased our income a bit and, at worst, was defrauding taxpayers and contributing corporate profits to both insurers and healthcare companies. This was a moral dilemma that was quite different than those I studied in my medical school medical ethics class. I now live in Charlottesville, Virginia, the headquarters of University of Virginia (UVA) Health. It recently came to light that administrators at UVA Health received a letter opens in a new tab or window about a year ago from 128 employed physicians, alleging that the leadership pressured them to engage in fraudulent billing practices and created a toxic work environment that endangered patients. Subsequent reporting opens in a new tab or window quoted physicians who were fearful of fines or even prosecution for complying with practices that they felt were unethical.

#medicalindustrialcomplex #upcoding - medpagetoday.com

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