You receive a bill from your doctor’s office for what you thought was a basic follow-up visit, but after closer examination of the statement, you realize you’ve been charged for a more comprehensive visit that clearly did not occur. Two explanations - an honest mistake or you were intentionally overcharged by upcoding.
Upcoding? What’s that? Upcoding is the deceitful medical billing practice that costs you money and perhaps health as well. It refers to a practice, in which a provider bills a payer, whether private, Medicaid or Medicare utilizing a CPT (Current Procedural Terminology) code for a more costly administration than what was performed. In other words, it’s a scam. An example is:
Dr. Scammer diagnoses Mrs. Jones with a broken leg. …show more content…
Horizon Blue Cross Blue Shield understands this and have taken some very aggressive, pro-active measures to combat fraud and abuse.
In 2015, Horizon Blue Cross Blue Shield’s Special Investigations Unit (SIU) -- generated $43.2 million in savings -- identified as a combination of monies recovered and losses avoided – and opened 988 new fraud cases. Since 2005, Horizon’s anti-fraud efforts have saved members $290 million.
“It takes the right intelligence tools, a no-tolerance approach and highly skilled investigators to accomplish the SIU’s primary objective, which is to detect and stop fraud activity as early as possible,” said Douglas Falduto, vice president of Administration and Chief Security Officer for Horizon BCBSNJ. “Through enhanced analytics tools and smart detective work that isolates suspicious patterns and anomalies in claims, the SIU brings an intense focus to fraud prevention.”
Consumers can take several steps to avoid being victimized by fraud:
• Treat your health insurance ID card with the same care you would a credit card; properly discard old insurance cards
• Beware of “free” services; although you the patient might not be charged, the provider can bill your health insurance
Upcoding? What’s that? Upcoding is the deceitful medical billing practice that costs you money and perhaps health as well. It refers to a practice, in which a provider bills a payer, whether private, Medicaid or Medicare utilizing a CPT (Current Procedural Terminology) code for a more costly administration than what was performed. In other words, it’s a scam. An example is:
Dr. Scammer diagnoses Mrs. Jones with a broken leg. …show more content…
Horizon Blue Cross Blue Shield understands this and have taken some very aggressive, pro-active measures to combat fraud and abuse.
In 2015, Horizon Blue Cross Blue Shield’s Special Investigations Unit (SIU) -- generated $43.2 million in savings -- identified as a combination of monies recovered and losses avoided – and opened 988 new fraud cases. Since 2005, Horizon’s anti-fraud efforts have saved members $290 million.
“It takes the right intelligence tools, a no-tolerance approach and highly skilled investigators to accomplish the SIU’s primary objective, which is to detect and stop fraud activity as early as possible,” said Douglas Falduto, vice president of Administration and Chief Security Officer for Horizon BCBSNJ. “Through enhanced analytics tools and smart detective work that isolates suspicious patterns and anomalies in claims, the SIU brings an intense focus to fraud prevention.”
Consumers can take several steps to avoid being victimized by fraud:
• Treat your health insurance ID card with the same care you would a credit card; properly discard old insurance cards
• Beware of “free” services; although you the patient might not be charged, the provider can bill your health insurance