decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Upcoding / Penalty
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Article Overview
This premium article discusses how upcoding is treated under federal enforcement law, including civil money penalty provisions and potential False Claims Act liability. It is aimed at coders, compliance staff, billing personnel, auditors, and healthcare administrators who need a high-level understanding of the legal and penalty framework surrounding overbilling concerns.
Why This Topic Matters
Upcoding can trigger significant financial exposure and government enforcement activity. Understanding the statutory and regulatory framework helps healthcare organizations recognize compliance risk and the types of penalties that may be associated with improper claim coding.
What You Will Learn
- How federal law addresses upcoding as a compliance issue
- The general categories of penalties and assessments associated with improper claims
- How civil enforcement and fraud-related remedies can intersect in upcoding cases
- Which government agencies and legal mechanisms are associated with these penalties
Who Should Read This
- Medical coders
- Compliance officers
- Billing specialists
- Healthcare administrators
- Auditors
- Revenue cycle staff
- Healthcare attorneys
Codes Discussed
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