Key findings:

  • Thousands of medical professionals have billed Medicare at progressively higher rates over a decade’s time, costing taxpayers at least $11 billion in inflated charges.
  • A significant portion of the added charges is likely due to “upcoding” — charging for more extensive and costly services than actually delivered.
  • Upcoding is facilitated by abuse of Medicare billing codes that reflect the range of care delivered and the time it takes. Many doctors have steadily billed the higher-level — and more lucrative — codes, while spurning those that pay less.
  • Some of the most dramatic surges in higher-cost billing codes have occurred in hospital emergency rooms. Hospitals are permitted to set their own rules for billing outpatient charges and these payments are seldom audited by Medicare.
  • The rise in costly coding and billing errors appears to be getting worse amid lax government oversight and the proliferation of electronic medical records systems, which critics say can facilitate abuse.

About this project | Methodology