Upcoding still a significant fraud issue - Updata - the Department of Justice and OIG are pursuing upcoding - Brief Article

Healthcare Financial Management,  Dec, 2002  

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In an indication that providers should continue to be especially diligent adhering to correct coding practices, the Department of Justice (DOJ) and OIG are still pursuing upcoding, and the OIG's plans for 2003 include examinations related to the aberrant coding. In a recent case, a hospital in Providence, Rhode Island, agreed to pay $400,000 to resolve allegations of Medicare fraud related to upcoding a pneumonia diagnosis to get greater payment than could be obtained if the correct, lower paying diagnosis code was used.

In a recent DOJ announcement, Assistant Attorney General Robert D. McCallum of the Civil Division said, "This settlement demonstrates our ongoing commitment to vigorously pursue allegations of fraud and abuse in the Medicare system."

See the DOJ press release at http://www.usdoj.gov/opa/pr/ 2002/October/02_civ_599.htm. The OIG Work Plan for 2003 is available at http://oig.hhs.gov/publications/workplan.html.

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