Insurers, particularly Medicare, tried to prevent upcoding by spot audits of charts, but hospitals provided helpful assistance to doctors. “It’s like a candy store—all you have to do is check the right boxes,” one doctor told me. “We had software for dictation, and it would even say, ‘You need to check two more boxes for level four.’” A questionnaire filled out by a patient can be labeled as a “health needs assessment,” which is a billable item. Injecting a patient’s bum knee with steroids can be coded as “surgery” costing $1,200. If the doctor uses an ultrasound machine to guide the needle
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