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).
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