Brought down by upcoding

For years William King ran a successful medical practice, but when his patients left his office, the Philadelphia, Pennsylvania, doctor had a practice of a different sort — a medical billing scheme known as upcoding. Fraud Magazine examines how King perpetrated a yearslong upcoding scheme that defrauded an insurance company of hundreds of thousands of dollars and details how fraud examiners can detect similar schemes.

On Feb. 5, 2008, inside a windowless room of the U.S. District Court for the Eastern District of Pennsylvania in Philadelphia, a grand jury was empaneled, busy deliberating whether to charge gynecologist William King on multiple counts of mail fraud, health care fraud and making false statements. That day, the grand jury decided to indict the doctor on 82 charges connected to a medical billing scheme that defrauded an insurance company of more than $750,000.