Upcoding is a fraudulent billing practice that occurs when a healthcare provider submits billing codes to payers for diagnoses or procedures that are more serious or expensive than the provider diagnosed or performed. Fraudulent billing is not only unethical; it is also illegal. How are you going to attack the problem of (intentionally or unintentionally) upcoding bills at Mercy Vale?
In August 2019, Baylor won a False Claims Act case over alleged fraudulent upcoding. The case claimed Baylor systematically schemed to wrongly bill Medicare more than $61.8 million over seven years but was dismissed, as the judge ruled the whistleblower couldnï¿½t substantiate the allegation.
In your discussion post, explain what happened in the case and the legal consequences and penalties. Next, look at the situation from a moral instead of a legal perspective and discuss what ethical responsibilities were ignored by the perpetrators.
After you post your initial response, react to at least two of your classmatesï¿½ initial posts. Do you have any recommendations on how to address such situations? Any success stories to share? Have you witnessed any consequences to bill-padding or inaccurate coding in your professional experience?
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