What type of misconduct does the term "upcoding" refer to?

Upcoding refers specifically to the practice of billing for a more expensive service than what was actually provided to the patient. This is a form of fraudulent behavior that misrepresents the complexity or intensity of the care provided in order to receive a higher reimbursement from insurers or government programs. Upcoding can occur when a healthcare provider intentionally assigns a higher code to a service, even though the service performed was less complex or invasive than indicated by that code. This fraudulent activity not only violates ethical standards but also legal regulations, as it can lead to incorrect billing and overpayment.

While the other options describe various forms of misconduct in healthcare billing, they represent different issues. Submitting claims for services not performed, for example, relates to outright fraud by charging for care that was never delivered, while providing unnecessary services pertains to medically inappropriate care to generate revenue. Failing to document services rendered accurately is a compliance issue rather than a fraudulent coding act. Thus, the specific nature of upcoding aligns directly with billing for a more expensive service than what was actually delivered to the patient.