Spreadsheet, calculator and magnifying glass CMS has implemented fraud prevention systems that would help identify diagnosis-related group (DRG) upcoding. (Photo: Shutterstock)

On July 20, the Office of Inspector General (OIG) released a report that found that hospitals are overbilling or upcoding hospitals to the tune of $1 billion.

OIG reviewed 200 claims made to Medicare that included a diagnosis of severe malnutrition and had a discharge date between Oct. 1, 2015 and Sept. 30, 2017 and found that 173 of them were not correctly billed under Medicare’s billing requirements. (OIG audited 224,175 inpatient claims in total and pulled a random sample of 200 for medical and coding review).

Complete your profile to continue reading and get FREE access to BenefitsPRO.com, part of your ALM digital membership.

Your access to unlimited BenefitsPRO.com content isn’t changing.
Once you are an ALM digital member, you’ll receive:

  • Critical BenefitsPRO.com information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events.
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com

Already have an account?



Join BenefitsPRO

Don’t miss crucial news and insights you need to navigate the shifting employee benefits industry. Join BenefitsPRO.com now!

  • Unlimited access to BenefitsPRO.com - your roadmap to thriving in a disrupted environment
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
  • Exclusive discounts on BenefitsPRO.com and ALM events.

Already have an account? Sign In Now
Join BenefitsPRO

Copyright © 2022 ALM Global, LLC. All Rights Reserved.