Business Commons^™

Implications Of Upcoding On Medicare, Katrina Cremeans, Samantha Marcum, Carli Followay, Jessica Oldaker, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The complexity of and amount of funds involved in Medicare has led to a significant increase in the incidence of Medicare fraud. A type of Medicare fraud, upcoding, has contributed to excessive and unnecessary health care spending. Upcoding has been an illegal strategy that some providers have used to increase their Medicare reimbursement for certain conditions. This is accomplished by coding a provided service as a more expensive service than what was actually performed. With the proliferation of upcoding, there has been an astonishing $12.5 billion in fraudulent Medicare charges since 2007. The fraudulent strategy of upcoding to increase Medicare …