Upcoding, a common medical fraud exposed

Sponsored by: MedReview (registration to this event is strictly limited by the sponsor)

Upcoding is a fraudulent medical billing practice which takes various forms, but typically involves inflating the complexity or severity of a patient’s condition. By assigning higher billing codes or more severe diagnoses than warranted for the services rendered and/or the patient’s condition, billing departments obtain higher reimbursements from insurance companies or government programs such as Medicare or Medicaid.

By upcoding, these provider departments aim to maximize their revenue by charging higher rates for services that do not align with the actual care provided. Upcoding not only defrauds insurance companies and government programs, but also leads to increased healthcare costs for patients and taxpayers (i.e., higher insurance premiums) and the resultant decreased accessibility to affordable healthcare.

To combat upcoding, insurance companies and government agencies employ various strategies such as audits, data analysis, and software algorithms to identify suspicious billing patterns. However, due to the complex nature of healthcare, it is not possible to fully assess a claim without reviewing the clinical record.

Ethical medical billing practices are crucial for maintaining the integrity of the healthcare system and ensuring fair and affordable healthcare for all.


Dr. Michael Menen
CMO, MedReview

Please note: This event is sponsored by MedReview, an NHCAA Platinum Supporting Member. Registration is limited and determined by the sponsor, and NHCAA cannot circumvent or alter the sponsor’s registration policies. Registration from personal email addresses and some organizations are not permitted. Please accept our apologies if you are unable to register for this particular event, however, NHCAA does offer other educational programs. Please click here to view upcoming educational opportunities.

The event is finished.


Jun 20


Eastern Time
1:00 pm - 2:00 pm