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:

Our 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 (version 11.3)]

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!

Intentional Unbundling

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.

Just call us at (888) 581-9132.