The Jewish Ethicist: Upcoding

The Jewish Ethicist: Upcoding


By Rabbi Dr. Asher Meir, Business Ethics Center of Jerusalem

Q. Insurers insist that every procedure be reimbursed according to its code. But sometimes a procedure that usually takes five minutes takes an hour. Can’t I record a higher-level code in order to get fair recompense?

A. The practice you describe is often called “upcoding” – recording a code for a procedure more expensive than the one the patient needs. It is recognized as a form of insurance fraud, or if the insurer is the government as a form of defrauding the government.

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