Upcoding and Unbundling-Medicare Fraud

According to the Centers for Medicare & Medicaid Services, more than 52 million Americans relied on Medicare for medical care services in 2013. Unfortunately,given the free-wheeling nature of the fee-for-service payment system, ripping off Medicare or Medicaid is rampant. If you have proof of systematic Medicare or Medicaid fraud, please contact an experienced Medicare fraud lawyer today at (845) 383-1728 to schedule your complimentary initial consultation.


Upcoding is a common qui tam complaint in the healthcare field.  Although CMS has some systems which are supposed to weed out inflated claims, the system is still quite porous and easy to game.  Upcoding commonly involves billing a service with more expensive CPT code than actually was performed or medically necessary. Do it 100,000 times, and we're talking real money.


Unbundling refers to breaking up and billing the component parts of a panel test or procedure to gain excess revenue.  There have been several successful qui tam suits alleging unbundling of lab panel tests.  Avoiding the use of the multiple procedure reduction rule, and staggering surgical procedures without medicial necessity is another example of unbundling.

Such health care fraud practices cost taxpayers millions each year and contribute to the ever-rising cost of quality medical care in this country. If you suspect Medicare fraud, you owe it to yourself, your family, and your fellow taxpayers to hold the guilty parties responsible. And you may be entitled to up to 30 percent of the reward. To discover how an experienced Medicare fraud lawyer can help, please contact the Law Office of James T. Ratner today at (845) 383-1728 to arrange a free consultation.
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