Report on National Upcoding Fraud Day began in 2017 when attorney Joel D. Hesch departed private practise to assist healthcare fraud whistleblowers.
August 21 is National Report Upcoding Fraud Day. An initiative launched by former Department of Justice attorney Joel Hesch. Hesch, a fervent advocate for whistleblowers, established the day for anyone reporting healthcare misconduct. He desired to simplify the procedure so that everyone could execute it correctly. The day raises awareness and provides specific instructions on how the public can report unethical healthcare providers.
Medicare fraud costs $65 billion annually due to fraudulently inflated reimbursement claims. Upcoding is one of the most pervasive forms of healthcare malpractice that must be eradicated.
Hesch uses his 15 years of experience as a Department of Justice attorney to support and encourage whistleblowers to come forward. The most effective claims share two characteristics: the use of facts and appropriate reporting channels. National Report Upcoding Fraud Day seeks to empower claimants with valid arguments.
Report on National Upcoding Fraud Day began in 2017 when attorney Joel D. Hesch departed private practise to assist healthcare fraud whistleblowers. Hesch was an attorney at the Department of Justice (DoJ) for more than 15 years. During his tenure at the Department of Justice, Hesch assisted in recovering approximately $1.5 billion from Medicare fraudsters. What did he find most satisfying? Assisting Medicare fraud whistleblowers in using the proper redress systems and claiming rewards. Fearing retaliation, whistleblowers are reluctant to speak up. Hesch not only ensured they submitted rewards, but also demonstrated the correct (and therefore secure) procedures.
Hesch published a book and a website to make this information more accessible. The resources describe various types of healthcare fraud and the reporting procedures for them. Each misdemeanour is extremely unique in terms of its reporting mechanisms and desired outcomes.
Upcoding is one of the most prevalent methods of Medicare fraud. Upcoding is a prohibited practise in which healthcare providers submit incorrect invoicing codes to insurers. In essence, the submitted codes would represent treatments that never took place. Medicare and Medicaid offer reimbursements based on codes. Regardless of the total payment cost, hospitals using the code for bronchitis receive a fixed amount. If they were to use the code for pneumonia, the amount paid would be greater due to the higher treatment costs associated with this condition. Upcoding deception refers to healthcare providers who use higher-paying codes to obtain additional compensation.
In his free e-book, Hesch details the appropriate methods for reporting upcoding fraud. Additionally, he led the effort to establish a national day for reporting healthcare fraud. The objective is to equip the public with the knowledge and facts required to claim rewards and prevent healthcare deception.
In 2014, the F.B.I. uncovered an oncologist in Detroit who prescribed painful cancer treatments to patients who did not have cancer, some of whom perished as a result.
A settlement of $12.64 million was paid by Sandoz for misrepresenting drug prices to Medicare.
In 2011, a healthcare administrator was prosecuted for connecting patients with physicians who performed unnecessary surgeries.
A group of con artists recruited children for a bogus after-school programme that required drug testing at a facility.
Three former NFL players submitted claims for medical equipment they never used totaling $2.5 million.
| Year | Date | Day |
|---|---|---|
| 2023 | August 21 | Monday |
| 2024 | August 21 | Wednesday |
| 2025 | August 21 | Thursday |
| 2026 | August 21 | Friday |
| 2027 | August 21 | Saturday |
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