Preventing upcoding and overbilling in your health care practice

On Behalf of | Jan 13, 2021 | Medicare and Medicaid Fraud

When you own a Florida health care practice, it is your responsibility to make sure your bills are accurate and that your staff members code all services accurately. Upcoding or overbilling may constitute Medicare fraud, which has the potential to land your practice in serious hot water.

According to Medical Economics, a recent ProPublica study is revealing how common upcoding and overbilling have become in American health care practices.

Study findings

The ProPublica study showed that, in 2015, about 490,000 health care providers welcomed at least 11 patients for standard office visits paid for by Medicare. More than 1,250 of those providers used the wrong code when billing Medicare for these services. They used code 99215, which should refer to visits that involve comprehensive exams, rather than standard checkups.

Study results also showed that 1,825 health care providers improperly billed Medicare for the most expensive type of office visit in 90% of all cases in 2015.

Prevention protocols

As a health care provider, there are certain steps you might take to lessen the chances of facing Medicare fraud charges. Establish firm billing and compliance standards, for starters. Also, consider hiring a compliance officer who is responsible for ensuring accuracy in all bills. You may also want to consider conducting internal monitoring throughout the year to make sure the bills your practice sends contain accurate information.

Often, problems relating to medical billing and coding arise because health care practice owners fail to devote adequate attention to training and overseeing their billing departments. Paying to train those within your billing department now may save you substantial money by helping you avoid litigation.


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