The only scammers of Medicaid & Medicare worth mentioning are the 100’s of companies that submit false claims or upcode for covered services. Florida is especially notorious for Medicare scams, foley caths, insulin syringes, homecare services, CPAP masks…
FRAUD is the drain that needs plugging
FRAUD is the drain that needs plugging
I don’t believe that there’s a ton of “scammers” on Medicaid.
I think that’s a distraction so people won’t care that tax cuts went to the rich at the expense of the vulnerable.
I do believe even the “scammers” should receive healthcare.
Why? Because it’s a basic human right
I think that’s a distraction so people won’t care that tax cuts went to the rich at the expense of the vulnerable.
I do believe even the “scammers” should receive healthcare.
Why? Because it’s a basic human right
July 15, 2025 at 11:40 PM
The only scammers of Medicaid & Medicare worth mentioning are the 100’s of companies that submit false claims or upcode for covered services. Florida is especially notorious for Medicare scams, foley caths, insulin syringes, homecare services, CPAP masks…
FRAUD is the drain that needs plugging
FRAUD is the drain that needs plugging
United Health rips off taxpayers for billions via Medicare Advantage; company docs upcode diagnoses & incent non-company docs to do same. You know those cowards at DOGE will never touch the real scammers & instead beat up helpless federal employees while expanding a program that’s already a ripoff.
UnitedHealth gave doctors checklists and bonuses linked to diagnosing the company’s #MedicareAdvantage patients. The process helped increase Medicare payments by billions. www.wsj.com/health/healt... via @WSJ
UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare
The biggest Medicare Advantage insurer presented physicians with checklists of potential diagnose.; “I didn’t think I was obese,” one suspicious patient told his doctor.
www.wsj.com
December 31, 2024 at 1:15 PM
United Health rips off taxpayers for billions via Medicare Advantage; company docs upcode diagnoses & incent non-company docs to do same. You know those cowards at DOGE will never touch the real scammers & instead beat up helpless federal employees while expanding a program that’s already a ripoff.
Have been saying this for almost a decade
Because I saw similar things while in practice
Being told to upcode for Medicare advantage patients to increase revenue
Because I saw similar things while in practice
Being told to upcode for Medicare advantage patients to increase revenue
Lee Fang @Infang
The new Senate report confirms WSJ reporting that UnitedHealth, based in Minnesota, systemically defrauds Medicare for billions by billing medical procedures doctors never performed.
But UnitedHealth has armies of lobbyists and is a huge donor so the gov response is more muted.
The new Senate report confirms WSJ reporting that UnitedHealth, based in Minnesota, systemically defrauds Medicare for billions by billing medical procedures doctors never performed.
But UnitedHealth has armies of lobbyists and is a huge donor so the gov response is more muted.
January 17, 2026 at 9:10 PM
Have been saying this for almost a decade
Because I saw similar things while in practice
Being told to upcode for Medicare advantage patients to increase revenue
Because I saw similar things while in practice
Being told to upcode for Medicare advantage patients to increase revenue
The weekend Meme Ward from @bobjherman.bsky.social's Health Care Inc newsletter: www.statnews.com/signup/healt...
#upcode #medicalClaims #RickandMorty
#upcode #medicalClaims #RickandMorty
September 29, 2026 at 6:32 PM
The weekend Meme Ward from @bobjherman.bsky.social's Health Care Inc newsletter: www.statnews.com/signup/healt...
#upcode #medicalClaims #RickandMorty
#upcode #medicalClaims #RickandMorty
Because of this, Medicare Advantage plans have a financial incentive to make beneficiaries appear sicker than they may be to receive a higher Medicare reimbursement.” (1)
In fact, a bipartisan bill, No UPCODE, eliminating incentives to overcharge Medicare for care was introduced in March.
🧵3
In fact, a bipartisan bill, No UPCODE, eliminating incentives to overcharge Medicare for care was introduced in March.
🧵3
June 17, 2025 at 11:35 AM
Because of this, Medicare Advantage plans have a financial incentive to make beneficiaries appear sicker than they may be to receive a higher Medicare reimbursement.” (1)
In fact, a bipartisan bill, No UPCODE, eliminating incentives to overcharge Medicare for care was introduced in March.
🧵3
In fact, a bipartisan bill, No UPCODE, eliminating incentives to overcharge Medicare for care was introduced in March.
🧵3
The No UPCODE Act would eliminate those incentives by:
* Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
* Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
🧵4
* Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
* Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
🧵4
June 17, 2025 at 11:36 AM
The No UPCODE Act would eliminate those incentives by:
* Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
* Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
🧵4
* Developing a risk-adjustment model that uses two years of diagnostic data instead of just one year.
* Limiting the ability to use old or unrelated medical conditions when determining the cost of care.
🧵4
As a would be medical coder who decided against the field back in 2020? This was extremely predictable, especially since medical coding data is incredibly easy to use manipulatively, whether that's predicting patient outcomes to deny insurance or using AI to upcode for profit based on old data.
September 29, 2026 at 1:47 AM
As a would be medical coder who decided against the field back in 2020? This was extremely predictable, especially since medical coding data is incredibly easy to use manipulatively, whether that's predicting patient outcomes to deny insurance or using AI to upcode for profit based on old data.
Which is CRAZY considering a healthcare company was recently being tried for trying to convince workers to upcode patients
June 2, 2025 at 2:09 PM
Which is CRAZY considering a healthcare company was recently being tried for trying to convince workers to upcode patients
Hospitals are using AI to upcode patient records, adding nearly $1B in claims over two years, averaging $12k more per case without changes in care.
Insurers are countering with automated denials. This is turning billing into an arms race of bot vs. bot with patients stuck in the middle.
#MedSky
Insurers are countering with automated denials. This is turning billing into an arms race of bot vs. bot with patients stuck in the middle.
#MedSky
Battle of Hospital A.I. vs. Insurer A.I. Is Pushing Medical Costs Higher (Gift Article)
The use of artificial intelligence by hospitals and health insurers is escalating their longstanding feud over paying for medical care.
www.nytimes.com
September 24, 2026 at 2:27 PM
Hospitals are using AI to upcode patient records, adding nearly $1B in claims over two years, averaging $12k more per case without changes in care.
Insurers are countering with automated denials. This is turning billing into an arms race of bot vs. bot with patients stuck in the middle.
#MedSky
Insurers are countering with automated denials. This is turning billing into an arms race of bot vs. bot with patients stuck in the middle.
#MedSky
Colorado's leaders are trying to figure out an $850 million budget gap. They could certainly use the tens of millions of dollars wasted after Medicaid service providers were told to upcode bill charges.
Colorado Medicaid overpaid wheelchair transport providers tens of millions in 5-year upcoding error
For five years, the Joint Budge Committee said transportation companies using vans for extra large wheelchairs were billing the state for a specialty ambulance.
www.9news.com
January 31, 2026 at 3:30 AM
Colorado's leaders are trying to figure out an $850 million budget gap. They could certainly use the tens of millions of dollars wasted after Medicaid service providers were told to upcode bill charges.
the billing AI arms race is the part that kills me. upcode vs auto-deny, both shipping in quarters while diagnostic AI is still stuck in FDA trials that take years
April 30, 2026 at 8:44 PM
the billing AI arms race is the part that kills me. upcode vs auto-deny, both shipping in quarters while diagnostic AI is still stuck in FDA trials that take years
when I was in practice our CMO actually directed us to upcode our Medicare advantage patients.
I refused to and was put under extra scrutiny
I refused to and was put under extra scrutiny
February 24, 2025 at 6:26 PM
when I was in practice our CMO actually directed us to upcode our Medicare advantage patients.
I refused to and was put under extra scrutiny
I refused to and was put under extra scrutiny
Every disease and its comorbidities are assigned an ICD-10 code that describes the condition. Medicare Advantage providers get paid by Medicare based on the severity of illness of the patients they treat. To get paid more, they upcode the diagnosis codes. This is fraud, but they all do it. 😡
January 1, 2025 at 4:00 AM
Every disease and its comorbidities are assigned an ICD-10 code that describes the condition. Medicare Advantage providers get paid by Medicare based on the severity of illness of the patients they treat. To get paid more, they upcode the diagnosis codes. This is fraud, but they all do it. 😡
1/ Caregiving in the US is a bitch. The scant free or low cost 'services' that exist in most states, on lower tier insurance plans, are predatorory AF.
They upcode patients on the sly, so they can overcharge Medicare by claiming the patient needs more expensive care.
*When* the patient dies...
They upcode patients on the sly, so they can overcharge Medicare by claiming the patient needs more expensive care.
*When* the patient dies...
February 9, 2026 at 1:39 AM
1/ Caregiving in the US is a bitch. The scant free or low cost 'services' that exist in most states, on lower tier insurance plans, are predatorory AF.
They upcode patients on the sly, so they can overcharge Medicare by claiming the patient needs more expensive care.
*When* the patient dies...
They upcode patients on the sly, so they can overcharge Medicare by claiming the patient needs more expensive care.
*When* the patient dies...
upcode it as a chronic ailment requiring an expensive and lightly regulated medical device?
March 5, 2025 at 1:36 AM
upcode it as a chronic ailment requiring an expensive and lightly regulated medical device?
The “No Upcode” Act goes after the waste, fraud & abuse by ins companies who take $80-140B ANNUALLY in PUBLIC dollars to increase their profits. They
1) upcode patient records to make them seem sicker
2) deny care for those people
3) pocket the difference
Why wouldn’t Repubes support? Hmmmmm??
1) upcode patient records to make them seem sicker
2) deny care for those people
3) pocket the difference
Why wouldn’t Repubes support? Hmmmmm??
Rep. AOC Breaks Down Medicare Advantage
YouTube video by RepAOC
youtube.com
June 3, 2025 at 2:54 PM
The “No Upcode” Act goes after the waste, fraud & abuse by ins companies who take $80-140B ANNUALLY in PUBLIC dollars to increase their profits. They
1) upcode patient records to make them seem sicker
2) deny care for those people
3) pocket the difference
Why wouldn’t Repubes support? Hmmmmm??
1) upcode patient records to make them seem sicker
2) deny care for those people
3) pocket the difference
Why wouldn’t Repubes support? Hmmmmm??
Yep. Large Language Models aren’t out there curing cancer. They are mostly being used as scribes who listen in on your conversations with your doctor and then try their best to upcode all their claims.
Forget grandiose talk of curing cancer - this is what AI is actually doing to healthcare.
In the words of one cardiologist: “it’s bots fighting bots, agents fighting agents, a horrible dystopic future nobody wants to live in.”
In the words of one cardiologist: “it’s bots fighting bots, agents fighting agents, a horrible dystopic future nobody wants to live in.”
September 27, 2026 at 11:16 AM
Yep. Large Language Models aren’t out there curing cancer. They are mostly being used as scribes who listen in on your conversations with your doctor and then try their best to upcode all their claims.
It’s got elements of what cynical people say about defense contracting, in that there’s huge incentives to upcode and bloat out prices, in part because the industry can’t function without it.
April 10, 2025 at 3:17 PM
It’s got elements of what cynical people say about defense contracting, in that there’s huge incentives to upcode and bloat out prices, in part because the industry can’t function without it.
you know what “rocks” is when the Epic AI “suggests” an upcode diagnosis that literally cannot be documented without specifying (eg “Traumatic Brain Injury (HCC)” -> TBI, with loss of consciousness, sequelae) so the notification never goes away or you accidentally clear the real TBI from the list
December 12, 2024 at 4:16 AM
you know what “rocks” is when the Epic AI “suggests” an upcode diagnosis that literally cannot be documented without specifying (eg “Traumatic Brain Injury (HCC)” -> TBI, with loss of consciousness, sequelae) so the notification never goes away or you accidentally clear the real TBI from the list
We also need to consider doctors who abuse the system for profit. I have VA healthcare. Went in for a colonoscopy. Doctor took biopsies that were unnecessary, putting me at risk, so he could upcode from a preventative to a diagnostic exam, more than doubling his bill back to the VA. It's disgusting.
December 10, 2024 at 9:31 PM
We also need to consider doctors who abuse the system for profit. I have VA healthcare. Went in for a colonoscopy. Doctor took biopsies that were unnecessary, putting me at risk, so he could upcode from a preventative to a diagnostic exam, more than doubling his bill back to the VA. It's disgusting.
My former CMO told all the docs to upcode everything so the company would get reimbursed more. Whether it was relevant or not. Seemed v fishy to me.
August 12, 2025 at 5:48 PM
My former CMO told all the docs to upcode everything so the company would get reimbursed more. Whether it was relevant or not. Seemed v fishy to me.
They “upcode” patient intensity for inflated premium & pocket the profits. The providers who do the work (hospitals, nursing care, doctors, etc) get squeezed. The care is sometimes inferior. Yes, a scam.
June 12, 2025 at 3:59 PM
They “upcode” patient intensity for inflated premium & pocket the profits. The providers who do the work (hospitals, nursing care, doctors, etc) get squeezed. The care is sometimes inferior. Yes, a scam.
A federal judge is letting a lawsuit proceed against UnitedHealth over claims it manufactured $3.3B in 2024 earnings to mask Medicare Advantage losses.
When your core business model allegedly involves paying doctors bonuses to upcode healthy patients, legal blowback isn't a surprise.
When your core business model allegedly involves paying doctors bonuses to upcode healthy patients, legal blowback isn't a surprise.
UnitedHealth Faces Securities Lawsuit Over $3.3B Medicare Advantage Scheme
A federal judge is allowing a massive investor lawsuit against UnitedHealth to proceed over alleged earnings manipulation.
zubiqo.com
October 1, 2026 at 1:56 AM
A federal judge is letting a lawsuit proceed against UnitedHealth over claims it manufactured $3.3B in 2024 earnings to mask Medicare Advantage losses.
When your core business model allegedly involves paying doctors bonuses to upcode healthy patients, legal blowback isn't a surprise.
When your core business model allegedly involves paying doctors bonuses to upcode healthy patients, legal blowback isn't a surprise.
p.s. If you're looking for heroes responding to insurer and provider abuses, how bout the journalists who exposed, say, UnitedHealth's denials-by-algorithm or their incentives to providers to overtreat and upcode?
December 12, 2024 at 11:46 PM
p.s. If you're looking for heroes responding to insurer and provider abuses, how bout the journalists who exposed, say, UnitedHealth's denials-by-algorithm or their incentives to providers to overtreat and upcode?