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what is upcoding

Upcoding is when medical coders fraudulently charge medical bills. It is a criminal act that can cost patients and insurance companies thousands of dollars.

How it works is the supplier bills a health care coverage payer (regardless of whether private, Medicaid or Medicare) using a CPT code for a more costly service than what was performed on the patient.

Upcoding is most certainly illegal, but that doesn’t stop people from trying to find ways to take advantage of the system. Providers that are attempting to cheat the system will use upcoding to pad their receivables beyond what they are rightly due from payers.

For individual patients and for taxpayers, upcoding is incredibly costly, as you can imagine. When it comes to patients, it can have a negative impact on their medical records. This process will put false information in their records, which will later influence the quality and amount of protection they are able to get in the future.