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identifying_and_addressing_upcoding_template.docx

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Identifying and Addressing Upcoding Template

Major Categories of Health Care Fraud and Abuse

Category of Health Care Fraud and Abuse	Description of Category and Example from Authoritative Source*
[Enter category of health care fraud and abuse here]	[Enter description of category and example from authoritative source here]
[Enter category of health care fraud and abuse here]	[Enter description of category and example from authoritative source here]
[Enter category of health care fraud and abuse here]	[Enter description of category and example from authoritative source here]
[Enter category of health care fraud and abuse here]	[Enter description of category and example from authoritative source here]
[Enter category of health care fraud and abuse here]	[Enter description of category and example from authoritative source here]

*Be sure to include the billing practice known as upcoding.

Five Health Care Fraud and Abuse Laws

Number	Health Care Fraud and Abuse Law	Description of Law	Rationale: How Does This Law Apply to Health Care?
1.	[Enter health care fraud and abuse law here]	[Enter description of law here]	[Enter explanation of how law applies to health care here]
2.	[Enter health care fraud and abuse law here]	[Enter health care fraud and abuse law here]	[Enter explanation of how law applies to health care here]
3.	[Enter health care fraud and abuse law here]	[Enter health care fraud and abuse law here]	[Enter explanation of how law applies to health care here]
4.	[Enter health care fraud and abuse law here]	[Enter health care fraud and abuse law here]	[Enter explanation of how law applies to health care here]
5.	[Enter health care fraud and abuse law here]	[Enter health care fraud and abuse law here]	[Enter explanation of how law applies to health care here]

Upcoding and the Law

Law Pertaining to Upcoding	Explanation of Upcoding	Case Example of Upcoding
[Enter law pertaining to upcoding here]	[Enter explanation of upcoding here]	[Enter case example of upcoding here]

Evidence-Based Recommendations to Address Upcoding

Recommendation*	Source
[Enter evidence-based recommendation to address upcoding here]	[Enter source for evidence-based recommendation here]
[Enter evidence-based recommendation to address upcoding here]	[Enter source for evidence-based recommendation here]
[Enter evidence-based recommendation to address upcoding here]	[Enter source for evidence-based recommendation here]
[Enter evidence-based recommendation to address upcoding here]	[Enter source for evidence-based recommendation here]
[Enter evidence-based recommendation to address upcoding here]	[Enter source for evidence-based recommendation here]

*Visit these websites:

· https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Avoiding_Medicare_FandA_Physicians_FactSheet_905645.pdf

· https://oig.hhs.gov/compliance/101/

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