Coding: Up, Down or Around?

Published
  • February 08 2013, 11:56am EST

The HHS warning was uncharacteristically blunt. In a letter distributed last September, Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital associations against using electronic health records to "game" the billing system. "There are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled," the letter said. "False documentation of care is not just bad patient care; it's illegal. These indications include potential 'cloning' of medical records in order to inflate what providers get paid. There are also reports that some hospitals may be using electronic health records to facilitate 'upcoding' of the intensity of care or severity of patients' condition as a means to profit with no commensurate improvement in the quality of care."

The letter-sent to the American Hospital Association, Federation of American Hospitals, Association of Academic Health Centers, Association of American Medical Colleges and National Association of Public Hospitals and Health Systems-sent a shockwave through the industry. HHS said it would step up monitoring of claims for any inappropriate activity, including "cloning"-or copying and pasting certain portions-of medical records from one visit to another. "We will not tolerate fraud," it said.

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