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

Published on: 19 November 2016 Last Updated on: 04 November 2024

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

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Over A Century Later, The Historic .303 British Is Still In Production

First adopted in the British service around 1902 and used across both World Wars, the .303 short magazine rifle cartridge was extensively used by many countries. Being the productive endeavor of the War Office Small Arms Committee, this entity even had the privilege of being called the ‘Universal’ component short rifle, as it swiftly replaced the pre-existing Lee Enfield designs in the infantry and cavalry. It also had the added advantage of features like charger loading and much more. Owing to how it was seen as a movement in the field of arms, popular manufacturers still seem to keep adding on features and tend to stick on to this gem of a design. Current standing Over the period of time, this sturdy piece of equipment was subject to several changes, mostly good but occasionally unnecessary. One could see that the list is quite extensive, but it would be more relevant to study the advantages which allowed such exponential growth. You can still find the .303 British being in common use and is manufactured in several units spread around the world by renowned producers like The Castle Arms. The fact that you still find this design standing speaks volumes for its own quality and fame. This critically-acclaimed cartridge has also been a forerunner for many of the new pieces you see in the current market. Basic dimensions Before getting into further technicalities, you should be familiar with the basic dimensions and details of the ammo. In simple terms for you to understand, the .303 British, also called the 7.7x56mmR, is a rimmed, bottleneck rifle cartridge. The .303 represents the bore of the unit, measured in inches. With a cartridge case capacity of 3.64 ml, this cartridge with the tapering exterior was designed with the goal of reliable case feeding and extraction. This was eventually satisfied, thanks to experts from different countries' repeated recommendations and experiments. Introduction in history Upon introduction, this British service rookie has termed a powder Mark, as it was initially designed by the British as a stop-gap round with black powder. This, combined with a boxer primer and full metal jacket, together with the round, was only used for a year. Introduced into service rifles in the year 1888, this addition was mainly to aid the Lee-Metford rifle, to be exact. Starting here, the rifle was constantly subject to improvements and the addition of features over time. In the year 1891, you would find that the cartridges were directed toward the usage of smokeless powder. This variant was made the standard cartridge for both British as well as Commonwealth military systems until the late 1950s when the 7.62 NATO sniper rifle type replaced it. Advantages based on popular opinion 1. The versatile nature of the rifle allows it to be customized. You can easily alter the Buttstock length by simply replacing it with another one you deem fit. You can even make a couple of changes to produce sniper variants, simply with a suitable scope mount. This is why you still find it classified as an assault weapon in a few states.2. The cost factor is definitely worth a mention. The .303 British is easily available and mostly at a price that is easy on your wallet.3. The detachable magazine with the possibility of loading 5-round chargers could be all you look for with your short rifle. This also allows you to use your rifle without worrying about rim jams. The .303 British in Hunting Thanks to its high praise and availability, this rifle cartridge was one of the most common components used for hunting all medium-sized games. If you look closely enough, you will still find that these cartridges are being used for hunting whitetail deer and black bears, especially in countries like Canada. This is due to the previous history of these cartridges being sold at low prices as it was part of the military surplus. Practical Usage The .303 was even named the standard hunting equipment for quite a while and has also been a popular component of the Canadian Rangers. This was mainly for its ability to fire long and heavy bullets with its unbelievably fast twist rate, paired with the lengths of measurements of the cartridge itself. The Canadians used it mainly for survival and polar bear protection. In Conclusion The .303 British can now be found in different variants, thanks to the amount of improvement and research that has been put in. A few of the most popular and outstanding upgrades would be the full metal jacket bullet, soft point, hollow point, boat tails, etc. The best part is that all these are still highly appreciated by professionals worldwide, and these cartridges remain one of the most widely used equipment of all time. Additionals: The Impact of Power and Politics Why Leadership Is A Great Skill To Have Within The Workplace? What Is the Nickname Of The Only U.S. President Born On The 4th Of July?

Uses and History of Prayer Beads in Various Traditions

You can find prayer beads in vast religions and cultures all over the world. The universal prayer items serve mainstream work in religions such as Hinduism, Islam, Christianity, Sikhism, Judaism, and Baha I faith. They are solely used to recite prayers, devotions, and chants. You can understand it with an example- Misbah and dhikr in Islam, and rosary in Catholicism. Countries such as turkey and Greece make use of Prayer Beads so as to relieve stress, tension, and passing time. Prayer beads are constructed through strings and beads thus the creation of a smooth beaded necklace is possible. Nearly all religions and traditions make use of the same typical style. They are fingered one by one in an automatic manner with the least effort. This allows the supporter to pay full attention without any distraction. You can find some of these through holy art nowadays. History of the Prayer Beads: The original exact of the prayer beads in unknown however in the late 500 BC it is said that Hindu follower in India makes use of it. It is whispered in the air that Buddhist followers invented it and later it got borrowed by Hinduism. You can see its evidence in the 3rd century BC a statue of a man holding beads. The concept of prayer bead got aired to the Middle East, China, and Japan from India. Originally it has its foot in Hinduism religion as well as tradition such as Japa Mala. Deity or mantra is termed as Japa and mala implies garland or wreath. In Muslim people call it Sufi, Tasbih, or Misbah. Worry beads are popularly known as prayer beads in Greece. Practitioners of Catholics make use of it in early tradition. Structure and style of prayer beads: The total number of beads found in a single string depends on usage and religion. For example, in Hindus and Hindus and Buddhists, the Japa mala has around 108 beads- 27 beads respectively which mean around 4 counts while in Islam, the Misabah could have 99 or 33 beads. 108 beads prayer beads are owned by the Sikh and the Baha'i prayer bead contains 95 – 19 beads with addition 5 beads. The rosary of Roman Catholic has 59 beads. The Orthodox Christians don’t have any prayer beads however it has knotted prayer rope. The rope is popularly known as Komboskini or chotki. In general, there are around 50- 33 knots in all chotki versions. In the 1980s, rev. Lynn Bauman introduced the rosary for Anglican. It has 33 beads. Worry bead is also known as greek Komboloi. It can be used for relaxation purposes and stress relief. What is the use of prayer bead in religion? Traditional prayer beads got made or constructed through strings with similar seeds, knots, and sized beads. Some of the prayer beads got made through crushed rose petals. It is generally a way of keeping track of prayer and recording. It is an important factor so as to keep the count of religion with symbolic structure. There are structured prayers beside the other bead types, they are symbolized as commitment. Interconnectedness among people can be symbolized via a circular bead. Each religion has its own style that is unique and thus you need to understand why it is so. Muslim prayer beads: At the core of Islamic tradition and religion, prayer beads are used for ages. It is well known that the concept of using a prayer bead is borrowed or taken from the Hindus religion. The bead could have 99 beads or 33 beads with one lead bead. The prayer bead represents or symbolizes each of the beads in name of Allah. The prayer bead string is called as misbaha or masbaha that implies “to praise”. It is basically made through date pits or wood from Mecca. They are even crafted using the olive seeds, ivory, plastic, amber, pearl, and stones. Earlier they are made using the pebbles and stones. Hindus Prayer beads: In 500 BC, the prayer bead origin can be tracked in Hinduisms. It is popularly known as “JAPA MALA” and has 108 beads. The prayer beads are used mainly for counting during repeating specific Mantra, Reciting, or chanting. They are solely created through “Rudraksha seeds”. The most common material used is pearl and plastic. Christian Prayer beads: Roman Catholic makes use of prayer beads in Anglican Churches. Rosary got originated from the Latin word rose garden or rosarium. It has 59 beads and that counts can be done in a specific sequence. Judaism prayer beads: Judaism considers prayer beads as Pagan. They are known as “Tallit” and have specific knots. The white and blue silk of Tallit contains 5 and 4 knots respectively. Sikhism prayer beads: The Sikh devotee makes use of prayer beads in the name of Guru Granth Sahib. They also wear attire that suits the bead. The prayer bead can be worn around the wrists. The Baha I faith: The Baha I faith recite around 95 times a day. Prayer beads can be often used to assist requirements. It contains 95 beads. Pagan faiths: The followers of pagan faith began using the prayer bead. They can be used to worship, or spell casting. They are basically attributed to one subject. Relaxation prayer beads: In Turkey and Greece, you can see the prayer bead and this helps in relaxing, relieving stress, and pass time. It improves cognition as well as mental power. It can cure allergies, headaches, and head diseases. Conclusion: No matter which tradition you belong to, you can know about the various prayer beads available in the market. This will help you in understanding more about it, and how it can be used. It is an integral part of one’s life. It keeps the practitioner during the chanting. It thus serves them full devotion toward the religion and protects them from corruption and harm. The modern beads are available online and you can see it. They are purely made of natural materials that are used in olden times. This may include Choerospondias axillaris, vyjanti, precatorious, and afzelia species. Read Also: Everything You Need To Know About Healing Gemstones And Materials Health Benefits Of The Amber Teething Necklace

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 Attorney 6 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!

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

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Over A Century Later, The Historic .303 British Is Still In Production

Uses and History of Prayer Beads in Various Traditions

Discusses the Growing Problems of Living Alone

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

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Citizenship by Investment program at CSB Group

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.

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Follow Us

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