In healthcare, which term best describes the act of changing a diagnosis to increase reimbursement?

The term that best describes the act of changing a diagnosis to increase reimbursement is coding fraud. This practice involves manipulating coding so that a healthcare provider can receive higher payments from insurance companies or government programs than they would for the actual services rendered. Coding fraud can occur when a provider intentionally uses incorrect codes or alters diagnoses inappropriately to secure greater financial gain.

Coding fraud is particularly problematic as it undermines the integrity of healthcare billing and can lead to significant legal repercussions for the provider, as well as increased costs for the healthcare system overall. It violates ethical standards and regulations that govern fair billing practices and can result in audits, fines, or even criminal charges against those involved.

In contrast, the other terms do not accurately encapsulate the specific act of changing diagnoses for financial gain. Misrepresentation generally refers to presenting false information, which could encompass various forms of deceit besides coding. Billing irregularities might cover a broader range of inconsistent or improper billing practices but does not specifically imply intentionality for financial enhancement like coding fraud. Cost shifting refers to the practice of reallocating expenses to different charges or payers, which is not the same as manipulating diagnosis codes. Thus, coding fraud is the most precise term for this unethical activity in healthcare billing.