Under-coding in Medicare Medicare physicians apply under-coding to avoid the risk of being audited by insurers. Medicare physicians are increasingly under-billing for a higher level of service provided. Under coding reduces the revenue earned by hospitals, however, under coding also reduces the reimbursement made to outpatients (Popp, 2000). Under coding may not be termed as fraudulent, but the mere fact that something is intentionally done in order to show a false figure signifies that it is fraud (Popp, 2000).
If hospitals are under coding Medicare patients stays with that of their visits they are indeed misrepresenting the truth. They may put up less revenue figures but reimbursement made to patients in terms of patient visits rather than patient stays will be less and it is fraudulent. The Medicare physicians and hospitals may escape the False Claim penalty because they are charging less for what they really earned, but it is misrepresenting the originality of the claim. Many physicians under code due to the fact that they fear being caught up under False Claim Act for a claim that may not be seen as original. So, it is better providing Medicare physicians with the necessary knowledge and coaching of accurately representing the claims in comparison to the services they provided, so there is no under or over representation of the claims.
Popp, A. J. (2000). Waging the War on Fraud and Abuse. American Association of Neurological Surgeons .