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What day is National Report Upcoding Fraud Day celebrated? August 21

What is National Report Upcoding Fraud Day? National Report Upcoding Fraud Day not only brings awareness to the amount of Medicare fraud but provides the public with detailed steps for reporting hospitals and other healthcare providers that cheat Medicare by lying about the level of medical services provided by upcoding. Ten percent of all Medicare funds are lost due to fraud. Because the government spends $650 billion a year on Medicare, $65 billion a year is lost to Medicare fraud. It’s no wonder why we have a national healthcare crisis! It’s time the public stands up and puts an end to upcoding fraud as part of Medicare fraud.

Who created this day? National Report Upcoding Fraud Day started in 2017. It was formed by The Hesch Firm, LLC after founding attorney, Joel D. Hesch, left government practice to help whistleblowers file for rewards. Mr. Hesch had devoted over 15 years working in Department of Justice whistleblower reward office where he helped obtain $1.5 billion in recoveries back for the government from those cheating Medicare. In the process, Mr. Hesch helped the government pay out hundreds of millions in rewards to whistleblowers. Mr. Hesch formed his own law firm and now exclusively represents whistleblowers nationwide in filing for rewards for reporting fraud against the government, including upcoding Medicare fraud. To help whistleblowers properly report Medicare fraud, including upcoding, he authored a free e-book on reporting Medicare fraud, and created a website to ensure that the public knows how to properly report Medicare fraud and follow the steps necessary to be eligible for a reward. Visit the website:

How to celebrate: Celebrate National Report Upcoding Fraud Day by visiting Mr. Hesch’s website or by downloading his free e-book so that you understand the various Medicare fraud schemes and the Department of Justice whistleblower reward program. The website and book explains the benefits and risks of reporting fraud and the various ways you can report upcoding Medicare fraud. If you have the right type of information, you can and should report Medicare fraud.

How to report Upcoding Medicare Fraud and received a monetary reward: There are two very different ways of reporting Medicare fraud, with two very different results. One is to report upcoding fraud under the Department of Justice (DOJ) reward program, which pays whistleblower rewards of up to 25% of the amount DOJ recovers. The average DOJ reward for reporting Medicare fraud is $690,000 and some rewards have been as high as $150 million! In addition, if you Medicare report fraud under the DOJ program, the government must open an investigation and inform you of the results. Thus, applying for a reward is the only way to ensure an investigation takes place (rather than just calling a hotline). Today, over three-fourths of the government’s Medicare fraud cases are DOJ whistleblower reward cases. Thus, the government is counting on whistleblowers to report upcoding fraud to DOJ and receive a reward in the process.

The other way to report all forms of Medicare fraud is to report fraud directly to the Centers for Medicare & Medicaid Services (CMS), which runs the Medicare program. The downside by reporting the fraud to CMS is that the reward is limited to $1,000 rather than the DOJ program that pays up to 25% with no limit or cap. You can report fraud directly to CMS through its website or by calling its hotline.

Here is a link to the CMS website:

Here the CMS hotline: 1-800-MEDICARE (1-800-633-4227).

Overview of Upcoding fraud

Many hospitals and health care provides cheat Medicare or Medicaid by upcoding their bills. Medicare and Medicaid typically reimburse providers using a prospective payment system (PPS). For instance, if they use the code for bronchitis, they get paid a set amount of money regardless of how much the treatment cost. However, if they use the code for pneumonia, they get paid a higher PPS amount because it generally costs more to treat that condition. Under upcoding fraud, a hospital or health care provider creates a scheme where they decide to use a higher paying code to cheat and collect more money. For instance, they routinely bill all Medicare patients that have bronchitis for the higher code of pneumonia.

The government pays significant rewards for reporting upcoding fraud to whistleblowers who know of intentional schemes to purposefully upcode the condition or treatment provided to patients under the PPS system.

Free E-Book for reporting Upcoding Fraud and Medicare fraud. To help whistleblowers properly report upcoding fraud (or any Medicare fraud), Mr. Hesch authored a free e-book on obtaining rewards for reporting fraud against the government. You can also go directly to Mr. Hesch’s website to start the process of filing for a whistleblower reward (