About a year ago, surgeons working for the University of Virginia Health System raised concerns they could face jail time for overcharging patients as they said their superiors were instructing.

The health insurance industry was caught off guard by the federal government's recent proposal to keep next year's payments to Medicare Advantage plans mostly flat, and to change a controversial ...

DENVER — If you ran a lemonade stand, and sold drinks for $1 per cup, you'd expect someone to pay you $1 for each cup. But if the customer gave you $10 for the cup, and kept coming back, and back, and ...

Kaiser Health affiliates have agreed to pay more than $556 million to settle allegations originally made by whistleblowers that they ignored compliance department warnings and unlawfully reworked ...

The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes ...

DEAR DR. ROACH: When I have appointments with my physicians (at our local, highly rated academic health system), they no longer do a physical exam. But in the after-visit note, there is a documented ...

A new study suggests "upcoding" practices are growing across outpatient service lines. The report, compiled by researchers at Trilliant Health, found that the share of visits that were coded at higher ...

Between 2018 and 2023, the number of visits coded at higher complexity levels grew across all outpatient settings, according to a study from Trilliant Health, published May 14. Here are five things to ...

Democrats are calling on GOP leaders to discard Medicaid cuts and instead address Medicare Advantage "upcoding" to tackle federal waste. In a letter to Senate Majority Leader John Thune and House ...