National Report Upcoding Fraud Day is on August 21. An initiative by Joel Hesch, a former attorney with the Department of Justice. Hesch and a passionate advocate for whistleblowers, created the day for anyone looking to report healthcare fraud. He wanted to make it easier, so everyone could get the process right. The day generates awareness and detailed steps on how the general public can report unethical healthcare providers.
Fraudsters siphon off $65 billion each year in Medicare fraud through inflated reimbursement claims. Upcoding is one of the most rampant types of healthcare fraud that must end.
Hesch draws on his 15 years as an attorney in the D.O.J. to support and encourage whistleblowers to come forward. The most successful claims have two things in common – facts and the use of proper reporting channels. National Report Upcoding Fraud Day aims to empower anyone with a legitimate case for claims.
History of National Report Upcoding Fraud Day
National Report Upcoding Fraud Day began in 2017 when attorney Joel D. Hesch left public practice to help whistleblowers report healthcare fraud. Hesch spent more than 15 years as an attorney at the Department of Justice (D.o.J.). During his stint at the D.o.J., Hesch helped the government recover about $1.5 billion from Medicare fraudsters. What did he find the most rewarding? Supporting whistleblowers report Medicare fraud via the correct redressal systems and claim rewards. Whistleblowers hesitate to speak up for fear of retaliation. Hesch not only ensured they filed rewards, but he also showed them the proper (therefore, safe) protocols.
Hesch even authored a book and published a website to make this information more accessible. The resources explain various kinds of healthcare fraud and how to report them. Each misdemeanor is vastly different from the next, along with its reporting mechanisms and desired results.
One of the most prevalent ways to cheat Medicare is through upcoding bills. Upcoding is an illegal practice where healthcare providers submit inaccurate billing codes to insurance companies. In essence, the codes submitted would reflect treatments that never happened. Medicare and Medicaid offer code-based reimbursements. Hospitals using the code for bronchitis receive a set amount regardless of the total payment cost. If they were to use the code for pneumonia, the amount paid would be more since treatment costs for it tend to be higher. Upcoding fraud refers to healthcare providers using higher-paying codes to get more money.
Hesch details the proper ways to report upcoding fraud in his free e-book. He also led the movement to create a national day for reporting healthcare fraud. The goal is to arm the general public with the knowledge and facts necessary to claim rewards and prevent healthcare fraud.
National Report Upcoding Fraud Day timeline
Congress passes the False Claims Act to address rampant corruption by defense contractors during the Civil War.
President Lyndon Johnson signs legislation establishing the Medicaid and Medicare programs.
Joel Hesch leaves behind a 15-year career as an attorney at the Department of Justice and establishes the Hesch Firm L.L.C.
A Florida chiropractor illegally obtains loans from COVID-19 relief programs and submits false reimbursement claims to Medicare.
National Report Upcoding Fraud Day FAQs
What are the most common types of health fraud?
Besides upcoding, healthcare fraud can include various kickback schemes. Companies may also charge patients for unnecessary medical services.
What is the largest area of healthcare fraud?
Scams involving telemedicine are some of the largest in healthcare fraud. The government has identified nearly $1.1 billion in fraudulent claims.
Why did Pfizer have to pay a fine?
Pfizer paid $1 billion in penalties as compensation to federal healthcare programs. The company marketed the drug Bextra for off-label usage, prescribing doses that were not officially approved.
How to Observe National Report Upcoding Fraud Day
Seek legal counsel
Do you have good reason to believe someone is committing healthcare fraud? Gather the facts and speak to a whistleblowing attorney right away.
Read up on the law
Familiarize yourself with the laws. Whistleblowing provisions vary across states and types of fraud. Understand them so that you know what to expect.
Take a different view
Contrary to perception, whistleblowers aren’t snitches. They put themselves at grave personal risk for the public interest. Encourage yourself and others to view whistleblowing in a positive light.
5 Facts About Healthcare Frauds That Will Blow Your Mind
Pain with no gains
In 2014, the F.B.I. discovered a Detroit oncologist prescribing painful cancer treatments to patients who did not have cancer and some of whom died.
Inaccurate drug price reporting
A company called Sandoz paid a $12.64 million settlement for misrepresenting drug pricing to Medicare.
Medical scam mastermind
In 2011, authorities prosecuted a healthcare administrator who connected patients with doctors to perform surgeries they didn’t need.
Unnecessary drug tests for kids
A group of scammers recruited children for a bogus after-school program where drug tests at a lab were mandatory.
N.F.L. retirees and false claims
Three former N.F.L. players submitted claims worth $2.5 million for medical equipment they never used.
Why National Report Upcoding Fraud Day is Important
Helping us get it right
We believe people can be inherently good. A day that offers tools (facts and accurate information) to do the right thing is what everyone needs.
The greater good
Reporting upcoding and other kinds of fraud can prevent injustice. Companies should not make profits off of people’s illness and suffering.
Sensitization and awareness
It’s high time we remove the stigma around whistleblowing. Without the fear of backlash, many more people may come forward with information about fraud.
National Report Upcoding Fraud Day dates