- An analysis of medical claims records by federal officials found that more than half of doctors claims for patient evaluations and related services came with incorrect codes or lacked needed documentation.
- An Office of Inspector General report Thursday said Medicare overpaid doctors by $6.7 billion in 2010, suggesting widespread physician upcoding.
- After looking at a large sample of claims, the OIG concluded that 26% of the claims were upcoded to reflect a higher level of severity than that which was justified by the patient's record, generating $4.6 billion in overpayments. 12% of claims weren't documented sufficiently, leading to $2 billion in overpayments.
Clearly, this is a widespread problem, as the OIG concluded that 55% of claims for E/M services had incorrect codes or lacked necessary documentation. That's a substantial percentage of the $32.3 billion Medicare paid out for E/M services that year. Still, it seems that doctors with a history of high coding (in the top 1% of their primary specialties) were most prone to upcoding in 2010.