[UPCODE.sub.475] shows no apparent reaction to the passage or effective date of HIPAAs anti-fraud provisions.
In part to combat this phenomenon, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed and several enforcement actions soon followed.
The present study extends prior research on upcoding by focusing on the effectiveness of the federal government's enforcement initiatives against upcoding: specifically, the effect of the passage of HIPAA along with related regulatory initiatives.
With respect to whether HIPAA and the enforcement actions were effective, we find that (1) upcoding was a growing problem prior to the passage of HIPAA, (2) upcoding was significantly reduced after the passage of HIPAA, and (3) the enforcement actions seem to have been effective in curbing upcoding.
Thus, while prior research has documented the existence of upcoding, questions remain about: (1) the effectiveness of government regulatory efforts to curb upcoding, (2) the factors associated with upcoding, and (3) whether HIPAA had a similar effect on all hospitals or whether some facilities experienced a greater change in upcoding than others.
Research Question 1: Was upcoding reduced by HIPAA and the subsequent enforcement actions?
HIPAA made numerous changes in order to curb Medicare/Medicaid abuse and expanded the reach of previous laws by making the defrauding of any private health plan a federal crime.
Trudel noted that the HIPAA rule gives the federal government the right to levy fines ranging from $100 per violation to a maximum of $25,000 on noncompliant covered entities.
For more information about HIPAA compliance, contact CMS via e-mail at email@example.com or call the HIPAA help line at 866-282-0659.