Complaint
HL-2026-04812
Upcoding on imaging services
Complaint text
Received Oct 27, 11:42 AM via Phone · Facility Philadelphia P&DC · ZIP 19104
Audit run against OWCP claims identified 27 instances where MRI services were billed at a higher CPT level than clinical notes support.
AI summary
Generated from the complaint narrative.
Automated audit flags upcoded MRI billings on 27 OWCP claimants at one clinic.
Similar prior complaints
Matched by program area and narrative similarity.
HL-2026-04811
Provider billing for unrendered PT sessionsHL-2026-04826
Provider billing for unrendered PT sessionsHL-2026-04827
Upcoding on imaging services AI classification
Suggested by the intake model.
Suggested area
Health Care Provider Fraud
Confidence56%
Priority score61
Assignment
Assigned analyst
D. Williams
Channel
Phone
Facility
Philadelphia P&DC
ZIP
19104