Tag Archives: upcoding

Shedding light on upcoding in the ER

Photo: Micheal J via Flickr

The Houston Chronicle’s Jenny Deam delved into emergency room billing – hospital facility fees as well as “upcoding,” which means categorizing relatively minor conditions as serious or even life-threatening ailments and charging a lot for them.

It raises costs to both the patient and the insurer. Continue reading

GAO confirms Center for Public Integrity’s findings on Medicare Advantage overspending

Fred Schulte

In a report last week, the U.S. Government Accountability Office confirmed what Fred Schulte and other journalists at the Center for Public Integrity (CPI) have been reporting on the Medicare Advantage program for two years.

In the report, “Medicare Advantage Fundamental Improvements Needed in CMS’ Effort to Recover Substantial Amounts of Improper Payments,” the GAO showed that CMS estimated that it improperly paid $14.1 billion in 2013 to insurers running Medicare Advantage plans. Continue reading