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

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

Funerals

3 Tips For Cheaper Funerals

When planning a funeral, financial costs always comes into play because expenditure will affect most of the funeral arrangements. This includes processes like paying the funeral home, catering for guests, as well as buying necessary items like flowers and caskets. Sometimes, one may want to plan a cheap funeral because it guarantees affordability. It also means that the funeral planners or the funeral director will have an easier time making arrangements that are not as extravagant. To arrange a cheap funeral, the most important thing is finding ways to cut costs throughout the process. This will end up reducing the overall budget. Below are some suggestions on how this can be done. Find ways to raise funds Before making an allocation as to how funds can best be used to conduct an affordable funeral, it is important to actually have the funds available. There are several ways in which this can be done while still ensuring that the money spent is minimised. One suggestion is to save up for funerals and such events. Some people prefer to set up a fixed deposit account where the funds can accumulate for use on a rainy day. Others may take out funeral insurance which can be a very wise idea. The money is paid in the form of a premium to an insurance company, and the funds are paid back during the planning of the funeral to cover costs. Lastly, the planners of the funeral can hold a fundraising ceremony, where relatives, friends, and well-wishers can donate to the funeral funds. All these methods will help in greatly reducing the cost of the funeral. Creating a favourable budget Once the funds have been raised, the next step is to specify how they will be used in the funeral process. The perfect budget for a funeral is one that allocates money in a way that reduces overall costs while still ensuring that the funeral goes as planned. This can involve prioritising what the money will be spent on and using it there first, to avoid depleting the funds before doing the important things. The right budget should also pick quality over quantity. Money spent on, say, quality funeral decorations, will save money in the end, than money spent on more items that have poor quality. Save on the funeral process itself There are ways to save money on the funeral process itself, and not compromise the ceremony. For example, cremation is a much less costly process than a burial. Services that are held in church, cost less than those held in a hired-out space. Of course, planning cheap funerals does not mean overlooking all the important funeral procedures. Everything possible should be done to ensure that the wishes of whoever the funeral is being planned for are respected. Any budget cuts should be done in line with this. Also, it is important to look at multiple options before settling on one, because that will ensure there is an alternative to choosing the most affordable one. All in all, a budget funeral does not have to mean a substandard one, and there are several ways to ensure that the ceremony is still beautiful and memorable.

READ MOREDetails
Black Magic Healer

How a Black Magic Healer Can Be Beneficial to You

The world is a mysterious place and tales of otherworldly beings and people possessing supernatural abilities still abound. Even today, there is much to discover and learn about the other dimensions of the world. One of the prevailing things from the darker side of history is the practice of black magic by witches and sorcerers. The popular notion was that they used their unholy abilities with the help of charms and incantations to place curses on their enemies, and the results were devastating. Their hapless victims may come down with debilitating diseases or go through varying intensities of physical and mental torture. Some become shadows of their former selves and slowly sink into unexplainable despair. You may have then heard of the witch hunts that took place during the middle-ages. People believed that some girls possessed dark powers that were used for evil deeds, causing hysteria that drove to their intense persecution. Very few people are aware of its continued existence, but black magic is still very much practiced in this time and age. There are still people who seek out a black magic healer to cure them of any sudden changes in behavior, odor, physical appearance, and mental state. How a Black Magic Healer Can Be Beneficial to You: Here are some facts to update everyone about the black arts and why it’s beneficial to know a black magic healer in case of an unfortunate event. Black Magic is Invisible: Black magic involves disrupting the elements by conjuring the power of evil spirits and demons. Unlike the myriad of magic circles that you have probably seen from children’s shows, black magic does not materialize in the real world. Instead, it remains invisible to human beings. Black magic practitioners communicate with evil spirits by inducing dark energy through negative emotions. Moreover, they practice underground or out-of-sight, so it’s almost impossible to detect whether somebody engages in black magic or not. Only a skilled, spiritual black magic healer will be able to identify any form of black magic. Black Magic Needs a Connection to You: Although black magic may seem omnipotent, it comes with significant limitations. For a practitioner of black magic to inflict curses and other damaging effects toward a victim, they would need to get hold of something that the person owns. For instance, a favorite trinket or photograph can be used as a catalyst to inflict harm. That is because remnants of the victim’s energy are attached to personal possessions. Thus, by visualizing the victim through a familiar, a curse placed on that object can transmit harm to the actual person. That is why you should be wary of people you have had a falling-out with, including stalkers. As the internet has made information on virtually anyone available, getting hold of your identity is not difficult. Once they find a photo of you, they can take away your sight, make you infertile, or make you lose all sense of reason. A lot of famous identities suddenly fell ill or disappeared from the face of the earth, and most would dismiss such incidents as natural occurrences or staying away from the limelight. But the few informed black magic users know that it’s the work of a skilled black magician. If a black magic healer had been contacted to help, then many lives would still be here today. Black Magic is Healable: When you detect that you or somebody you know may be affected by black magic, know that there is still hope. A skilled black magic healer will be able to create the proper talismans and other magical items required to break away the evil spells. These healers work on a spiritual level and are the antithesis of those who delve in black magic. All you need to send them are essential pieces of information, such as your name and your parents’ name, location, and the like. As with inflicting black magic, the reversal process also requires aspects of yourself to find spiritual imbalances and create the best cure. Spiritual healers are the only ones who can cut the effects of black magic while retaining the essence of the person. As a result, the victim can return to normal in no time. Read Also: Why Should I Hire An Intuitive Life Coach? Stoke Your Spirit: 4 Soulful Ways To Reach Spiritual Wellness And Lead A Calmer Life A Man And His Watch: Iconic Stories Of Watches That Withstand The Test Of Time

READ MOREDetails
Carbon Capture Projects

10 Carbon Capture Projects Around the World

Carbon capture projects, and storage projects, abbreviated as (CCS projects), is a climate change mitigation process whereby CO2 emitted into the atmosphere from industrial processes or power plants is recycled. The availability of carbon capture enables the continued use of fossil fuel in generating electricity as it is possible to reduce carbon emissions. For us to achieve a significant reduction in carbon emission, large amounts of CO2 need to be captured and stored. CO2 gas emission is the leading cause of global warming as it brings about the greenhouse effect, which negatively impacts the environment. Globally there are three main carbon capture methods which are: post-combustion, oxy-combustion, and pre-combustion. These capture methods are applicable in various industrial processes like cement and clinker production, water desalination, oil and gas refinery, iron, and steel industry. Don't forget to reach out, why we should care about the environment. Drawing from the Intergovernmental Panel on Climate Change (IPCC) 2020 data, carbon capture helped capture and store about 40 million tonnes of CO2 globally from power plants and industrial facilities. In order to achieve net-zero emissions by 2050, the carbon capture and storage rate should increase at least 100 folds. Many countries in the world embrace carbon capture like Australia, China, Korea, Algeria, Norway, Netherlands, the Middle East, New Zealand, and the most being in the United States and Europe. Most of the carbon dioxide captured and stored in natural gas plants, iron and steel industries, or coal fields is transported via pipelines to oil fields and used in Enhanced Oil Recovery (EOR). The wise decision for oil and gas field owners is to consult with professionals with a vast knowledge of CO2 enhanced oil recovery. Consulting companies like Melzer Consulting offer their services to clients like oil producers, CO2 source companies, and research organizations. Some of the resources and projects include transmissive fracture detection, wettability, residual oil zones. CO2 EOR and C02 ROZ school. Carbon Capture Projects Around the World Let's explore some of the carbon capture and storage projects around the world: 1. Petrobras Lula, Brazil Lula oil field is one of the largest ultra-deepwater oil and gas producing fields in the Santos Basin. This oil field produces about a million barrels of oil per day as of 2019 and is expected to reach its peak by 2021. Since 2013, the oil and gas field has incorporated carbon capture; about 0.7 million tonnes of CO2 are recycled and used in enhanced oil recovery annually. 2. Boundary Dam, Saskatchewan, Canada The Boundary Dam is a coal-fired plant located in Estevan, Saskatchewan, Canada, and has six production units. The coal-fired plant was commissioned in 1959. In 2014, the Boundary Dam Power Station completed its carbon capture unit. The captured project used carbon for Enhanced Oil Recovery (EOR). Installation of the carbon capture and storage equipment helped convert Unit 3 into a reliable producer of clean-base electricity in the province. The plant is responsible for capturing a million tonnes of CO2 emissions per year. 3. Petra Nova CCS project, Texas, US The WA Parish power station burns coal and gas. The plant has partially retrofitted post-combustion carbon capture equipment. This unit generates 240 MW and captures about 1.4 million tonnes of carbon per annum. The gas is transported via pipeline to West Ranch Oil Field and used for enhanced oil recovery. 4. Abu Dhabi CCS Project, United Arab Emirates Abu Dhabi is the pilot plant with commercial carbon capture and storage facilities in the iron and steel industry. Carbon dioxide is a by-product of the production of steel and iron metals. Instead of emitting the CO2 into the atmosphere, it is captured and transported via pipeline to the region's National Oil Company and used for EOR. Over 40% of the gas emitted proves helpful in crude oil production. 5. In Salah, Algeria Salah is an operational onshore gas plant that began its carbon dioxide stripping and storage back in 2004. The CO2 is captured and filtered during natural gas extraction. The plant was suspended in 2011 over concerns of possible leakage. The plant had stored about 3.5 million tonnes of CO2 in a saline aquifer. The site is currently valuable for monitoring, modeling, and verification for future storage. 6. Uthmaniyah Demonstration Project, Saudi Arabia The Uthmaniyah demonstration project was operational from 2015. Its primary purpose was to capture about 0.8 million tonnes of carbon dioxide released at the world’s largest oil field, Ghawar. The captured gas is transported via a 70km pipeline to the oil fields and used in EOR. 7. CNPC Jilin Oil Field, China The CNPC Jilin oil field was China’s first carbon capture project in Jilin province. The source of CO2 is a nearby gas field responsible for extracting about 22.55% of natural gas. The separated carbon dioxide is transported via pipeline and injected in EOR at the low-permeability oil field. So far, the project has injected over 1.1 million tonnes of carbon dioxide. 8. Quest, Alberta, Canada The Quest carbon capture project is a joint venture between Marathon, Shell, and Chevron Oil designed to capture about a million tonnes of CO2 gas. The hydrogen production facility was designed to convert bitumen from oil sands into synthetic crude oil. CO2 gas is a by-product in the hydrogen production process, and the unit captures, transports, and stores the gas in a deep saline aquifer. 9. Gorgon Injection Project, Australia The Gordon Project is one of the most significant natural gas projects in the world. As of 2020, the project produces an average of 2.1 billion cubic feet of natural gas. The carbon capture unit will capture about 3.3 million tonnes of CO2 stripped from the natural gas. The carbon dioxide is stored in a saline aquifer. 10. Sleipner, Norway Sleipner is an offshore gas field initiated in 1996. The CO2 separated from the natural gas is stored in the Utsira saline aquifer, about 800-1000m below the ocean floor. This large-sized reservoir accounts for about 600 billion tonnes of stored CO2. It is safe to say that carbon capture, utilization, and storage are being embraced by many countries globally. The acknowledgment of the importance of capture, removal, and storage of carbon leads to the launch of carbon capture projects around the world. With the help of new policies and carbon capture, the results may have a significant climate impact. Carbon Capture Efforts in the Future Although carbon capture technologies have yet to be deployed on a large scale, the number of projects under development across the world has been steadily increasing. This is due to a combination of greater private sector ambition and more supportive policies. However, we will need much greater investments and governmental assistance to successfully decarbonize by implementing CSS at the scale required. Read Also: The Effect of Climate Change on Human Health The Benefits of Solar Lighting in a Nutshell

READ MOREDetails