Certified Fraud Examiner Practice

"DRGs creep" refers to the practice of changing service codes to artificially increase reimbursements within the healthcare system. Diagnosis-Related Groups (DRGs) are a classification system used to determine how much hospitals are paid for particular services based on the diagnosis of a patient.

When healthcare providers engage in DRG creep, they may alter the coding associated with patient diagnoses in order to justify higher reimbursement rates. This might involve billing for more complex diagnoses or services than what were actually provided, thus inflating the amount that is claimed from insurers or government programs. Such practices can ultimately lead to increased healthcare costs and impact the integrity of billing practices.

This concept highlights the potential for fraudulent behavior in healthcare billing, as it can lead to misrepresentation of services rendered, ultimately undermining the purpose of DRGs, which is to fairly and accurately reimburse providers based on actual patient care.