DOJ says court documents show Carolinas upcoded numerous tests, triggering higher payouts from government programs.Carolinas Healthcare System will shell out $6.5 million to settle a major whistleblower lawsuit that alleged the system was ratcheting up testing codes to get bigger payments from federal healthcare programs the Department of Justice has announced.The DOJ said court documents show that from 2011 to 2015, Carolinas conducted urine tests that should have been categorized as “moderate complexity” tests when being coded for government reimbursement. This classification dictates the amount that would be reimbursed for the test. However, the tests were coded as “high complexity” tests instead, triggering a higher payment of $20.00. This practice is known as “upcoding.”Carolinas Healthcare System will shell out $6.5 million to settle a major whistleblower lawsuit that alleged the system was ratcheting up testing codes to get bigger payments from federal healthcare programs the Department of Justice has announced. The DOJ said court documents show that from 2011 to 2015, Carolinas conducted urine tests that should have been categorized as “moderate complexity” tests when being coded for government reimbursement. This classification dictates the amount that would be reimbursed for the test. However, the tests were coded as “high complexity” tests instead, triggering a higher payment of $20.00. This practice is known as “upcoding.”

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