Remove or Replace: Header Is Not Doc Title
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/
5
1
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