Up-Coding Leads to Legal Action & Major Cash Settlements

WARNING: DO NOT UP-CODE.

The state of Georgia accused Grady Health System of inflating billings for services it provided in its neo-natal intensive care unit. Grady will need to pay $3 million to settle the allegations. The hospital coded claims that allowed them to receive unjustified payments from Georgia Medicaid.

The practice of "up-coding" is more common in health systems, medical groups, and medical billing companies than most people think. Healthcare providers should be cautious when chasing money for procedures they did not provide and healthcare specific vendors need to reiterate to their clients that precise documentation is essential to proper payment. 

It is understandable that sometimes money can be tight, but inflating billings for services they provided is not the right way to enhance your company's revenue. It can also lead to a multi-million dollar settlement and even jail time. It is also not the best idea to claim unjustified payments from a governmental payor.

Summary by www.MedicalGroups.com

Click here to read more from www.MedicalGroups.com on "up-coding" 

To read more from WABE.org, Atlanta's NPR network click here