Your primary duty is to care for your patient. Unfortunately, you aren’t given carte blanche to do so. Your care must fall within the lines of hospital and clinic rules. There are also state and federal regulations to which you must adhere, as well as your ethical obligations.
All of these factors can impede your ability to provide the type of care you feel your patient deserves. Sometimes, it can be tempting to flout the rules to help your patient get the treatment they need. Some medical professionals may perform an end-run around rules and regulations by engaging in a practice known as upcoding. While you may believe you are doing what is morally right, upcoding is considered a form of billing fraud. Upcoding could put your medical license at risk.
What does upcoding look like?
Upcoding can take a variety of forms. One example would be exaggerating a patient’s condition to help avoid an early discharge. Other examples may involve splitting one test into two or reporting symptoms that your patient hasn’t complained about to secure a medical test.
It can be easy to justify upcoding. What’s the harm in blurring the lines once in a while if it gets your patients the help they need? Is anyone even likely to notice an occasional bending of the rules?
Keep in mind it only takes one administrative audit or one instance of a colleague to report what you’re doing to find yourself in legal hot water. You could face criminal fraud charges in addition to civil actions, including the loss of the license you have worked so hard to obtain. A skilled legal professional can help you defend your license and your career.