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Outpatient PPS False Claim

A false claim submitted by a hospital outpatient department that defrauds medicare’s prospective payment system by upcoding the appropriate APC. Although this typically involves upcoding it can also fit into other healthcare fraud categories as well. See Ambulatory Payment Classification Fraud in this Glossary.

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The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential False Claims Act case falls within our case requirements. If it does, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential defendants are not necessary at this point, should you feel more comfortable omitting them.) By law, all communications to us are 100% confidential.

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