tci Medicare Compliance & Reimbursement - 2017 Issue 13

Industry Notes: DOJ Case Illustrates the Woes of Upcoding

Shoot for necessity and accuracy when billing for the services you render. Upcoding sits atop the HHS Office of Inspector General’s hitlist. Sometimes upcoding occurs because of documentation errors or the EHR identifies the service under a higher-paying code. But in one North Carolina case, a provider knowingly upcoded to the tune of $6.5 million. The Department of Justice’s (DOJ) qui tam case concerns a Charlotte-area organization, Carolina Healthcare System (CHS), which repeatedly billed urine drug tests under a higher-paying code from 2011 to 2015. The feds discovered that CHS was upcoding “by submitting claims...

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