Unbundling Services & Bills
Atlanta Attorney for Unbundling Fraud
Do you know about a healthcare provider that is unbundling medical services
or lab tests so that it can charge more to Medicare or Medicaid? U.S.
taxpayers are losing money! Stop the fraud today by becoming a whistleblower.
File a False Claims Act qui tam lawsuit with the help of our Atlanta medical
fraud attorney at Atlanta. Whistleblowers who help the Government get
money back receive between 15% and 30% of what the Government recovered.
Our lead attorney, Lee Wallace, graduated with honors from Harvard Law
School. She devotes her practice to representing individuals like you
who are sick of watching medical providers figure out how to unbundle
their charges so that they can drain more from the state and federal healthcare programs.
Learn more about unbundling fraud below:
consultations are provided FREE of charge.
What Is Unbundling?
According to the Centers for Medicare & Medicaid Services (CMS):
- Unbundling occurs when multiple procedure codes are billed for a group
of procedures that are covered by a single comprehensive code. Two types
of practices lead to unbundling. The first is unintentional and results
from a misunderstanding of coding. The second is intentional and is used
by providers to manipulate coding in order to maximize payment....
[National Correct Coding Initiative Policy Manual for Medicare Services
To put it simply, unbundling is like if you bought a Happy Meal that was
listed for a certain price, but instead of handing you a bill for the
Happy Meal, McDonald’s puffed up the price by billing you separately
for the hamburger, the bun, the cheese, the ketchup, the mustard, the
pickle, the fries, the salt, the cup, the ice, the drink, the straw --
and even the prize!
CMS acknowledges that some unbundling “is unintentional and results
from a misunderstanding of coding.” However, the agency is quick
to add that some unbundling “is intentional and is used by providers
to manipulate coding in order to maximize payment.”
The False Claims Act does not cover the first type of unbundling; if a
coder truly makes an error, CMS simply expects the company to correct
the mistake and refund any money that should not have been paid.
On the other hand, the False Claims Act very definitely covers the second
type of unbundling: hospitals and doctors who make “knowing”
violations, which the Act says means anyone who:
- Has actual knowledge of the information;
- Acts in deliberate ignorance of the truth or falsity of the information; or
- Acts in reckless disregard of the truth or falsity of the information. . . .
31 U.S.C. § 3729(b).
Failing to Reimburse Medicare/Medicaid After Realizing Unbundling/Overbilling
The False Claims Act also covers situations where a medical provider learns
that it made a mistake by unbundling some charges that should have been
billed as a unit — but then never gets around to reimbursing Medicare
and Medicaid for the amounts the programs overpaid.
Tired of watching waste and fraud? When you file a successful False Claims
Act lawsuit, you can stop fraud against U.S. taxpayers
and the Government will pay you a percentage of the amount you help it get
back from the cheaters. Find out more about filing a lawsuit to stop medical
providers who are overcharging Medicare and Medicaid by unbundling services
when they bill.
Our attorney can review the specifics of your case.
call us at (888) 581-9132.