Derek Thompson

So Tim, Mike has just laid out a scenario where the insurance company has coded me as full-blown type 2 diabetic, full-blown dementia, and also as a person suffering from skin cancer. This is a scenario where it's the insurer with their foot on the accelerator for adding diagnostic codes. You're the doctor. Are there also some cases where it's the doctor who's so-called up-coding him or herself?

What I find so interesting about this and stories like this is I am such a sucker for cases where seemingly good intentions can go awry because we've established it seems to make so much sense that we would want to find a way to make patient sickness legible to the government And the way we discovered to do that, or the way we arrived at, is diagnostic codes.

What I find so interesting about this and stories like this is I am such a sucker for cases where seemingly good intentions can go awry because we've established it seems to make so much sense that we would want to find a way to make patient sickness legible to the government And the way we discovered to do that, or the way we arrived at, is diagnostic codes.

What I find so interesting about this and stories like this is I am such a sucker for cases where seemingly good intentions can go awry because we've established it seems to make so much sense that we would want to find a way to make patient sickness legible to the government And the way we discovered to do that, or the way we arrived at, is diagnostic codes.

But Tim and Michael, as you've explained, there's all sorts of reasons for both the insurer and the doctor to pretend as if their patients are sicker than they actually are, because the more severe the diagnostic code, the more money everybody in the system gets. So Michael, this is a practice that is known in healthcare as upcoding.

But Tim and Michael, as you've explained, there's all sorts of reasons for both the insurer and the doctor to pretend as if their patients are sicker than they actually are, because the more severe the diagnostic code, the more money everybody in the system gets. So Michael, this is a practice that is known in healthcare as upcoding.

But Tim and Michael, as you've explained, there's all sorts of reasons for both the insurer and the doctor to pretend as if their patients are sicker than they actually are, because the more severe the diagnostic code, the more money everybody in the system gets. So Michael, this is a practice that is known in healthcare as upcoding.

And both of you published a paper several years ago showing evidence that upcoding is not just a hypothetical in Medicare Advantage, but a likely fact in Medicare Advantage. Before we talk about like the history and how to fix this, how do we know you're right? What is the best evidence that this is happening at a wide scale?

And both of you published a paper several years ago showing evidence that upcoding is not just a hypothetical in Medicare Advantage, but a likely fact in Medicare Advantage. Before we talk about like the history and how to fix this, how do we know you're right? What is the best evidence that this is happening at a wide scale?

And both of you published a paper several years ago showing evidence that upcoding is not just a hypothetical in Medicare Advantage, but a likely fact in Medicare Advantage. Before we talk about like the history and how to fix this, how do we know you're right? What is the best evidence that this is happening at a wide scale?

So this is really clear evidence that Medicare Advantage enrollees are being deliberately coded as being significantly more sick than equivalent patients are in the public Medicare system. And This is costing Medicare, therefore the federal government, billions of dollars a year.

So this is really clear evidence that Medicare Advantage enrollees are being deliberately coded as being significantly more sick than equivalent patients are in the public Medicare system. And This is costing Medicare, therefore the federal government, billions of dollars a year.

So this is really clear evidence that Medicare Advantage enrollees are being deliberately coded as being significantly more sick than equivalent patients are in the public Medicare system. And This is costing Medicare, therefore the federal government, billions of dollars a year.

According to the GAO, FBI, upcoding and related misrepresentation of clinical information costs somewhere between $10 and $100 billion to the U.S. federal government annually. This is why we're looking here for waste or fraud. Very quickly, Michael, before I go back to Tim on the history of this practice. What's the difference between waste and fraud?

According to the GAO, FBI, upcoding and related misrepresentation of clinical information costs somewhere between $10 and $100 billion to the U.S. federal government annually. This is why we're looking here for waste or fraud. Very quickly, Michael, before I go back to Tim on the history of this practice. What's the difference between waste and fraud?

According to the GAO, FBI, upcoding and related misrepresentation of clinical information costs somewhere between $10 and $100 billion to the U.S. federal government annually. This is why we're looking here for waste or fraud. Very quickly, Michael, before I go back to Tim on the history of this practice. What's the difference between waste and fraud?

And what's the right way to think about this upcoding phenomenon we're talking about today as being waste, improper payment, or fraud, someone's actually lying here?

And what's the right way to think about this upcoding phenomenon we're talking about today as being waste, improper payment, or fraud, someone's actually lying here?

And what's the right way to think about this upcoding phenomenon we're talking about today as being waste, improper payment, or fraud, someone's actually lying here?

Tim, the term that we've used today is upcoding, and contained in that term suggests the idea that there is an optimal code that we should use for people, and that Medicare uses the right code, and Medicare Advantage upcodes, therefore uses the wrong code.