Upcoding is billing the insurer for a higher level of service than actually rendered.

• A. True
• B. False
• C. Not enough information
• D. Not applicable

Answer: (A)

Upcoding is a fraudulent billing practice where a provider uses a higher-level code than the service actually performed or documented, aiming to receive more money from the insurer. The statement matches this definition exactly, so it’s true. In practice, this could mean billing for a comprehensive visit code when only a brief check occurred, or charging for more complex tests or imaging than were done. This is illegal and commonly flagged in audits because it shifts costs to the insurer and can trigger penalties. The other options don’t fit because the statement is a clear, definitional description of upcoding, so there isn’t a need for extra information, and labeling it false or not applicable would contradict the standard understanding.