Have You Heard of Upcoding? It’s a Big Part of Medical Fraud

by

19 November 2016

Society

What does the term “medical fraud” conjure up in your mind? Do you picture a questionable-looking character going door to door, soliciting personal information of Medicare beneficiaries? Maybe you see a fake doctor administering tests to unsuspecting patients in a dingy medical facility.

Sure, these exaggerated caricatures aren’t out of the realm of possibility, but it’s often the case that fraud in the healthcare industry is much subtler, to the point that it can occur to almost anyone without their knowledge. It even happens in the sleekest looking medical facilities, and it can be perpetrated by professionals that one would seldom suspect of being a fraudster.

One of the most “subtle” and common forms of medical fraud has a name that belies its simplicity. It’s called upcoding, and while that might sound like a boring, complicated system, it’s quite easy for a medical professional to do.

Upcoding is the practice of billing for services other than those provided. It some cases, it’s essentially just overbilling, and it’s one of the easiest ways for a provider to earn a little extra money without risking being noticed by the authorities or by patients.

Before we look at just how prevalent this practice is, it’s important to understand that virtually every medical service has a code to which it is associated. These codes are very specific, and a provider lists the code of the service they provided their patient either to the patient themselves or to the insurance company that will pay for the service.

When a doctor is guilty of upcoding, it means that they provided a different code than the one representing the service that was provided. While some forms of upcoding are blatant, and could easily be spotted by someone who simply took the time to notice, others are so slight that they would go undetected unless someone was paying close attention.

For example:  You see your doctor for a checkup. You schedule your appointment, sit patiently in the waiting room, see your doctor for about 10 minutes, pay your co-pay and you go home. Meanwhile, your doctor has billed you for pretty much exactly what transpired during your visit, with one major exception. Instead of billing you for the 10 minutes he spent with you, he bills you for a much longer period of time. You likely never looked at your bill, and it would be difficult for an insurance provider to say that he didn’t spend that extra 20 minutes in your presence.

These face-to-face interactions are some of the easiest for a doctor’s office to “fudge” the numbers ever so slightly in a way that is difficult for anyone to dispute. When time or, more specifically, face-to-face interactions are the services being billed for, it leaves a much larger margin for error or, in this case, for fraud.

In addition to face-to-face time, upcoding can also occur when services billed are simply inflated versions of the service provided, whether that be a test or a treatment of a patient. In these cases, even some of the most medically savvy or attention-detailed patients might not catch the fact that they paid for something that doesn’t reflect what they received.

Upcoding is so common, in part, because it is so easy to do without getting caught. Investigators are always on the lookout for upcoding as one of the first signs of a fraudulent medical provider. For the aforementioned reasons, it’s not always easy to discover upcoding without the cooperation of someone who is familiar with the services and billing practices of a facility. This is one of the reasons that whistle blowers are so important to the process, and it’s also one of the reasons that whistle blowers are often employees of the company or facility that has committed fraud.

And that’s the simple story of one the grossest and most widespread forms of medical fraud in the United States. While we don’t know exactly how much money is taken from programs like Medicare because of upcoding, investigators suspect that it is very significant and it is common.

So, pay attention the next time you look at your medical bill. The chances are good that your facility was completely justified in the amount that you were charged, but there is also a slight chance that there is something there that is just a little off – and that slight difference might be part of a larger system that defrauds patients and costs taxpayers vast sums of money.

Bert Louthian is a whistleblower attorney in South Carolina who focuses on helping those who have been wronged, or who have witnessed wrongdoing to come forward to report fraud. He can be reached by calling or visiting his website –thewhistleblowerlawyer.com

Read Also:

Content Rally wrapped around an online publication where you can publish your own intellectuals. It is a publishing platform designed to make great stories by content creators. This is your era, your place to be online. So come forward share your views, thoughts and ideas via Content Rally.

View all posts

Leave a Reply

Your email address will not be published. Required fields are marked *

Related

Living Alone

Discusses the Growing Problems of Living Alone

Researchers have concluded that living alone, being socially isolated, and feeling lonely can pose significant health risks, particularly in older adults. Although the terms living alone, social isolation and loneliness are often used interchangeably, they are not the same thing. Specifically, living alone and being socially isolated are objective determinations either that a person lives solo, or has few relationships or infrequent social contact. According to the Administration on Aging (a division within the U.S. Department of Health and Human Services), nearly one-third (28%) of non-institutionalized adults 65 and older – 13.8 million people – live alone. Despite living alone, however, these adults may or may not be included within the category of social isolation depending on the nature of their relationships and the frequency of their social contacts.In contrast, loneliness is determined on a subjective basis. Loneliness is based on a person’s individual feelings of disconnectedness, isolation, or not belonging. Said differently, loneliness arises because of the divergence between a person’s desired level of social connection and the actual level of connection. To be clear, a person living alone may not necessarily feel lonely, whereas someone living with a number of other people may still experience loneliness. Risk Factors A recent survey of older adults determined that 43% feel lonely on a regular basis. More concerning is that among those who report feeling lonely, there is a 45% increased mortality risk. Steve Cole, the director of the Social Genomics Core Laboratory at UCLA, explains: “Loneliness acts as a fertilizer for other diseases. The biology of loneliness can accelerate the buildup of plaque in the arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.”Research has established links between living alone, social isolation, and loneliness to a variety of physical and mental conditions, including high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death. Indeed, a recent meta-analysis – representing cumulative evidence from 148 studies involving over 300,000 participants – determined that greater social connection is associated with a 50% reduced risk of early death. A second meta-analysis by the same researchers – representing cumulative evidence from 70 studies involving more than 3.4 million participants followed for an average of 7 years – similarly concluded that living alone (objective determination), social isolation (objective) and loneliness (subjective) each had a significant effect on the risk of mortality. Specifically, the analysis concluded that the likelihood of death increased a statistically significant 26% for loneliness, 29% for social isolation, and 32% for living alone. To put those risks in context, the researchers determined that the magnitude of risk is comparable to – and in some cases even exceeds – other well-accepted risk factors such as smoking (up to 15 cigarettes a day), obesity, lack of physical exercise and high blood pressure.Loneliness has also been associated with increased emergency admissions to a hospital, longer length of stays, and delayed discharges. In fact, a November 2017 study concluded that the lack of social contacts among older adults is associated with an estimated annual increase in Medicare spending of $6.7 billion. One Can Be the Loneliest Number, But it Doesn’t Have to Be Greg Bishop, an attorney in Park City, suggests that retirement is a great opportunity to develop the types of connections that can prevent or alleviate the health consequences of living alone, being socially isolated, or feeling lonely. He notes that although there is a general consensus about the potential problem areas, the solutions are more elusive. He explains that although living alone and being socially isolated are determined objectively, the underlying causes are overtly personal. For example, living alone may be the result of the death of a partner or because of a recent divorce, whereas being socially isolated may arise from relocating after retirement or from the children moving away. Given that the underlying causes vary drastically, the solutions for living alone, being socially isolated, and feeling lonely will also differ. In short, there is no one-size-fits-all solution to these issues.That said, older adults will likely benefit from the following suggestions:Proactively stay involved in the lives of your family and friends. Find meaningful ways to connect with them via video chats, phone calls, text messages and letters Establish new social connections – go to the gym, take a dance class, learn to play chess, or join a book club Establish a more meaningful relationship with a church or social groups Look for opportunities to help and serve others. Fred Rogers – the television icon from Mister Roger’s Neighborhood – shared that when he was a boy and saw scary things on the television news, his mother told him to “Look for the helpers. You will always find people who are helping.” While that advice comforted him as a child, perhaps better advice for older adults dealing with social isolation and loneliness would be to “Look to be a helper. There are always people who are in need of help.”Read Also: Why Do You Need a Queens Personal Injury Attorney6 Signs That You Need To Hire a Personal Injury Attorney Don’t Battle It All Alone: 5 Reasons Why You Need an Adoption Attorney These Four Qualities Are What You Should Be Looking For In Attorneys! 

READ MOREDetails
baptism decoration ideas

4 Baptism Decoration Ideas That Even the Holy Spirit Will Love

Although it is difficult to look at the statistics of baptisms in every church, it's clear that the rate has been declining for years and many churchgoers are wondering why. Baptism decoration ideas are very popular and everyone should know it.Perhaps people have forgotten about the importance of this sacrament and take it too lightly, and maybe they need someone to remind them what it's all about. 4 Baptism Decoration Ideas That Even the Holy Spirit Will Love We've pulled together some great baptism decoration ideas so that the next time you're organizing a party for this momentous occasion, it gets the recognition it deserves. 1. Water Theme: Since the baptism is a water-centric sacrament, many people try to use themes centered around the idea of water. Oftentimes that shows up like Noah's Ark table decorations and cakes.But in actuality, Noah's Ark isn't really a cute kid story about a bunch of animals sailing around the world in a boat. It's a story about God wiping out the entire planet to rebuild since He saw so much sin amongst humanity.There is no reason that you should want your child's baptism to be associated with such a cataclysmic event. But that doesn't mean you can't use a water theme.Consider instead renting fountains, placing floating candles in glass bowls along with flower blossoms, and strategically placing nice glass pitchers of water around the party. 2. Cross Footprint: This decoration idea may be strange for adult baptismal candidates. But if your baby is coming up on their baptism, how about considering marking the occasion by casting an impression of their feet in concrete?To give the decoration a religious spin, you can cast the concrete in a cross-shaped container. That way you can always have a marker to remember the precious moment when your child began their relationship with the Lord. 3. Hanging Doves: Many baptisms have an extensive floral design and some have a theme. But very few families actually pay attention to the meaning behind the baptism and use decorations that make sense.The white dove has always symbolized the Holy Spirit. And baptism is the moment when the Holy Spirit enters you and washes you free of sin. By hanging doves at your baptism, your guests will know that you understand the true meaning of the baptism and take it seriously. 4. Photo Gallery: Many people love to get photos taken for their babies ' baptisms. Adults to take time to mark the occasion, often hiring professionals to capture one of the most important moments of their lives.But beyond using the photos for your baptism announcement, you can repurpose them as decorations at the party.Consider hanging the photographs in a cross-shaped pattern and choose the best images from your session. If you want to, you can send guests home with the images as keepsakes. What Are The Symbols Can Be Used For Baptism Party Decoration?    Most of the popular symbols that can be used in the baptism decorations in most of the cases are used with one entrance of the family. Symbols can be certainly special verses, phrases, verses, and the child's blessings.Some of the common forms of the symbols that are used worldwide for baptism are as follows:- 1. Angels    In your Baptism decorations, Angels offers a holy touch and it offers a great religious significance. 2. Crosses  Crosses form the central theme of religious significance as it is one of the holy symbols of the Christianity. 3. Doves    Doves are the symbol of peace and it is added in the holy spirit and it is one of the elegant theme of baptism. 4. Bibles    Bibles are another themes of baptism that resembles the holy spirit as it is one of the religious books of Christianity. 5. Praying Hands    The image of the praying hands is one of the essential symbols of serenity and the purity that you must not ignore at your end. Beyond Baptism Decoration Ideas: More Life Advice: Now that you have these great baptism decoration ideas in your back pocket, you're ready to throw the ultimate party.Check out our blog for more helpful lifestyle advice today. You have to understand the facts before making your choices in the correct direction. Read Also:Unique Christmas Gifting Ideas- Gifts For Everyone 7 Startup Essentials Entrepreneurs Should Know About

READ MOREDetails
Are there more doors or wheels in the world?

Are There More Doors Or Wheels In The World?

Having silly debates on the internet and having heated arguments and virtual bloodshed over it has become pretty common nowadays. Very few seem to have a common ground regarding such heated debates. However, one such debate that gained comical notoriety was this question - are there more doors or wheels in the world?Well, if you want to find the answer to this question, then you are in the right place. If you want some solid evidence as to which option is the right answer (unbiased of course), then read this post till the end.How Many Doors Are There In The World?When it comes to the viability of what will be considered as how many doors are there in the world for this poll, all doors are considered here. This includes, but is not limited to various forms of doors (even the unexpected ones).For this debate, I will be considering doors as “doors” that connect two spaces together. It can be between spaces. Therefore, the doors in your room, windows, oven, car, house, and everything that resembles one will be taken into consideration. This includes:Residential household doorsVehicle doorsToy vehicle doors (only if openable)Cabinet doorsDrawer doorsCupboard doorsBunker doorsWindows doorsOven doorsHow Many Wheels Are In The World?What type of wheels must be considered for this poll is subjective. However, for its discussion on this post, all wheels will be considered here. This includes actual wheels that are present in vehicles, along with other wheels present in car toys, trolleys, and more.For the sake of simplicity, any circular wheels that help in moving objects around will be considered as a wheel. In addition, circular objects that simply rotate might also be considered wheels, though this is subjective. This includes the wheels in hand-drawn carts, pulleys, and lots more.Therefore, for this discussion, such wheels in “how many wheels are in the world” will be taken into account:Vehicle wheelsToy car wheels (Hot Wheels anyone?)CartwheelsSkateboard wheelsWheelchair wheelsLawn Mower wheelsGear cogs and wheels in machinesSince When Did People Care About Debate This Anyway?People will always care about any pointless debate on social media since they are fun and you get to flex your knowledge online.The debate about how are there more wheels or doors in the world was first started online on Twitter. It was first started by Ryan Nixon from New Zealand. He randomly made a poll post on Twitter asking users “is there more doors or wheels in the world?” This Twitter poll was posted on 5th March 2022.However, since it's social media, who knew this question would cook up such a storm?Even though Ryan has only 2,000 followers on Twitter, more than 220,000 votes were cast on this poll. This left Ryan flabbergasted and surprised at the overwhelming response. Later, many claimed that this poll spread like wildfire, and it was shared with thousands of people on other social media platforms as well. Sharing this post on WhatsApp and TikTok also made it pretty popular as well.So, according to Ryan’s poll, are there more wheels than doors?Doors VS Wheels: Who Wins In This World?So, in the end, who is the winner of the debate: are there more wheels or doors in the world?The answer is - there are more wheels in this world than doors.According to the original Tweet made by Ryan, the poll also provided the same answer. As per the results of this poll, 54% of the votes said wheels while 46% said doors.When it came to the question, there was an entirely new war brewing regarding this question. Those who said wheels argued that each car has four (or more) wheels - including the millions of toy cars as well. In addition, each door has wheels on them - the door hinges. Here, one even argued that each door is a wheel in itself, but it’s not the same the other way around!On the other hand, many “Team Door” followers claimed that doors can be mystical as well - referring to the door to our hearts and minds as well. While each person has various opinions regarding this question, we should be happy with the answer provided by the poll for now.Frequently Asked Questions (FAQs):Many people interested in finding out if are there more doors or wheels in the world answer have asked various questions. Here are my answers to those questions.Q1. What Does Team Doors VS Team Wheels Mean On TikTok? Ans: When people asked about “are there more doors or wheels in the world statistics” through TikTok, the opinions of people differed. Those who thought that there were more wheels joined Team Wheels. On the other hand, those who thought that there are more doors in the world joined Team Doors. Q2. Do Doors Have Wheels On Them? Ans: Yes, it’s true that doors have wheels on them. This statement is true because all doors have hinges in them. You can consider hinges to be a wheel since they are circular in shape and rotate too!Final Verdict: Are There More Doors Or Wheels In The World?So, are there more doors or wheels in the world?The answer is there are more wheels in this world compared to doors. This is because there are millions of automobiles in this world, with all of them having two to six wheels. Plus, the greatest argument ever here is that all doors have wheels on them - the door hinges.If you want answers to such silly (but interesting) debates, why not start a fire yourself in the comments below?Read Also:How to Check If Your Car Tires Are Good?Why Should you Consider Security Doors for Your House?How To Choose The Best Wheels And Tires For Your Vehicle?

READ MOREDetails