ReviewPerspectives in health information managemen2021
UPCODING MEDICARE: IS HEALTHCARE FRAUD AND ABUSE INCREASING?
Review in Perspectives in health information managemen, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed.
- Inappropriate Rehabilitation Claims and Financial Burden in Japan: Analysis of Reports from the Board of Audit of Japan.JMA journal · 2026Article
- Too Sick to be True? Evaluating Potentially Problematic Diagnosis Coding Practices in Medicare's Patient-Driven Payment Model.Health services research · 2026Article
- Validity and Predictors of Medical Claims Coding for the Identification of Patients with Obesity.Journal of health economics and outcomes research · 2026Article
- Article
- Understanding and Addressing Upcoding.Health services research · 2025Article
- Pancreatic cancer risk prediction using deep sequential modeling of longitudinal diagnostic and medication records.Cell reports. Medicine · 2025Article
- Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research.Healthcare (Basel, Switzerland) · 2025Article
- Opaque ontology: neuroimaging classification of ICD-10 diagnostic groups in the UK Biobank.GigaScience · 2025Article
- Incidence of Parkinson's disease in Germany based on prevalence data from 70 million patients of the statutory health insurance.BMC neurology · 2024Article
- Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Article
- Evaluation of inpatient services of tertiary comprehensive hospitals based on DRG payment.Frontiers in public health · 2024Article
- The impact of commercial health datasets on medical research and health-care algorithms.The Lancet. Digital health · 2023Review
- Overview of telehealth in the United States since the COVID-19 public health emergency: a narrative review.mHealth · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements. The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding has had an impact on Medicare payments and fraud. Medicare fraud has been reported to be the magnitude of upcoding inpatient and outpatient claims throughout Medicare reimbursements. In addition, fraudulent activity has increased with upcoding for ambulatory inpatient and outpatient charges for patients with Medicare and Medicaid.
Indexed as
Identifiers
34975355PMC8649706What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.