How to Report Upcoding the Easy Way

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How to Report Upcoding the Easy Way

Upcoding may sound like a new vocabulary, but in Medicare, it is a severe and frequent fraudulent offense that has caused immense losses to the federal government every year. Medicare officials have been stealing from American taxpayers and senior citizens through upcoding.

Upcoding is a form of fraud where doctors or hospitals forward patients' incorrect billing codes to their insurance companies to receive higher reimbursements. The inaccurate current procedural technology (CPT) shows that doctors provided the patients with more costly and complex treatments than they received.

Luckily, patients have a way to report healthcare fraud to hold these officials and organizations accountable for the action. We can help you solve all issues concerning upcoding and other Medicare fraud through DoNotPay.

Easy Steps to Personally Report Upcoding

Medical billing is not easy in the United States for medical staff and patients. Most treatments are also costly, and the expenses of visiting a hospital or seeing a doctor may be extremely high. As if that is not enough burden to patients, there exist unethical medical experts who want to get extra money from the patients' pockets. For instance, your doctor may bill you for treatment you never received.

If you notice your bill is higher than the procedures you received, you must consult your doctor or the hospital. Sometimes it can be a genuine mistake or some mix-up that can be easily corrected. Other times, it is a medical billing fraud that you need to report.

The following are the easy steps you should follow to .

  1. Contact the hospital or the doctor. Bring the billing mistake to the attention of your doctor or hospital as soon as you notice the error. You can do this by visiting the hospital, using the contact information on the website, or calling the hospital's main number and asking for the officer in charge of billing disputes.
  2. Request the Chief Financial Officer's contacts. If the hospital or the doctor does not solve your problem, request to speak to the Chief Financial Officer. Explain the error to the officer and request corrections. In several circumstances, asking to contact the Chief Financial Officer will trigger some seriousness in the billing department resulting in your issue being resolved.
  3. Contact the Department of Health in your state. Contact DOH if you are self-conscious that you have been fraudulently billed and your hospital, doctor, and Chief Finance Officer have not taken action. Such a department typically has a medical board in charge of evaluating fraudulent billing claims and unethical medical conduct. The committee will investigate the matter on your behalf.
  4. Report the issue to your insurance company. In most cases, your insurance company will settle most of your medical expenses. Therefore they will be willing to listen to your suspected fraud reports. The insurance company will contact the hospital or the doctor and inquire about the treatments you have been billed for.
  5. Report the matter to the State Insurance Fraud Bureau. If your insurance company cannot resolve the matter, report them to the State Insurance Fraud Bureau. In rare cases, your insurance company may collaborate with the hospital, offering you services to hike your bills. You must report the company to the State Insurance Fraud Bureau during such events. The bureau will further investigate and take action.
  6. You may contact their billing unit directly if your healthcare is registered under the Affordable Care Act. Report your experience by quoting the hospital name, supplies, operations, treatments, and charges.
  7. Report it to Medicare. Remember you have the responsibility to report Medicare upcoding, and you can be held liable if you don’t.
  8. You can also contact the US Department of Health and Human Services – Office of the Inspector General. The OIG provides oversight for upcoding frauds by physicians.
OfficePhone Number
Medicare1-800-MEDICARE (1-800-633-4227)
The U.S. Department of Health and Human Services – Office of the Inspector General1-800-368-1463
State Insurance Fraud BureauCheatline


DoNotPay Will Conveniently Help You Report Upcoding

If you are sure your friend or a family member has been fraudulently billed in a hospital, let them know they can get help. You can also take action on their behalf and file a complaint with DoNotPay.

For DoNotPay to help you report upcoding or unbundling and other Medicare medical fraud, all you need to do is the following:

  1. Search Fight Medical Fraud on DoNotPay.

  2. Tell us the date of your visit, what you were treated for, and where you were treated.

  3. Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code.

  4. Choose the correct CPT code or let us know if you want us to find it for you.

  5. And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction.

Why Do You Need DoNotPay to Solve Your Matters?

DoNotPay focuses on helping anyone struggling with personal issues such as and other medical billing fraud. Once you engage DoNotPay, you are sure of the following benefits:

  • Easy: It will take you only a few clicks of the mouse to have DoNotPay resolve your issue on your behalf.
  • Successful: DoNotPay has resolved more than 250,000 personal information challenges, with the success stories serving as evidence.
  • Fast: DoNotPay makes personal solving matters very easy. It takes only a few minutes!

DoNotPay Can Help You Further

Besides how to report upcoding, DoNotPay can also help you with:

DoNotPay will help you find the correct CPT code to your medical bill and demand corrections on your behalf so you can get your money back. Join us today!

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