Webinar: Unveiling the Truth on Upcoding – Exposing a Common Medical Billing Fraud

Webinar: Unveiling the Truth on Upcoding – Exposing a Common Medical Billing Fraud

MedReview to present “Best Practices in Leveraging Clinical Validation for Payment Integrity” at AHIP 2023

MedReview’s Chief Medical Officer Michael Menen, MD, will present the webinar “Upcoding, a common medical fraud exposed,” on Tuesday, June 20, at 1 pm ET. Co-presented by MedReview and the National Health Care Anti-Fraud Association (NHCAA), the webinar explores how the unethical medical billing practice of upcoding leads to increased costs and decreased accessibility to affordable healthcare. Menen will also discuss strategies to combat upcoding, and the value of clinical validation to uncover fraudulent billing.

Providers are incentivized to maximize revenue by charging the highest possible rates for a particular condition or procedure. Upcoding is a practice that inflates the complexity or severity of a patient’s condition so that providers obtain higher reimbursements from insurance companies or government programs (e.g., Medicare and Medicaid). Upcoding not only defrauds these organizations, but also leads to increased costs for patients via higher insurance premiums, making healthcare financially inaccessible.

“Mistakes in medical billing are surprisingly common, and while some are the result of unconscious human error, others, unfortunately, are a deliberate attempt to secure higher reimbursement,” says Dr. Menen. “As medical claims become more complex, clinical validation is the most thorough way to assess a suspicious claim and uncover upcoding practices.”

As CMO at MedReview, Dr. Menen provides clinical direction on behalf of the organization, develops innovative programs and strategic partnerships, and is ultimately responsible for ensuring payment integrity programs are compliant and clinically accurate – and that MedReview’s findings hold at appeal. Prior to joining MedReview, Dr. Menen was the CMO at Optum Health and UnitedHealthcare.

MedReview offers healthcare payors innovative, physician-led payment integrity solutions to help fight healthcare fraud, waste, and abuse. The company’s clinically driven approach to DRG coding and claims reviews saved clients $351 million in 2022.

Register for the webinar: https://attendee.gotowebinar.com/register/4642681682453754718


    About MedReview
    Headquartered in the financial district of New York City and serving all U.S. states and territories, MedReview has been a leading provider of payment integrity, utilization management and quality surveillance services for more than 40 years. A physician-led organization with a passion for ensuring that health care claims fairly represent the care provided, MedReview provides timely independent hospital billing audits and clinical validation reviews on behalf of health plans, government agencies and Taft-Hartley organizations, saving millions of dollars for its clients each year.

    Jennifer Ringler

    Categories: Press Release|