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Medicare Unbundling
Billing Medicare for medical services is done using a complicated system of numerical codes that designate various procedures and diagnoses. Reimbursements are based on these codes.
Unbundling is where health care providers seeking to increase profits will "unbundle" the services, tests, or care they provided into smaller components, billing each smaller item separately to increase profits. Medicare often has special reimbursement rates for a group of procedures commonly done together, such as typical blood tests. This is illegal and is a form of Medicare Fraud.
Qui tam is a whistleblower lawsuit brought by an “informer” or “whistleblower” under a provision of the Federal Civil False Claims Act that allows private citizens to file a lawsuit on behalf of the United States Government alleging fraud, kickbacks, or misuse of government funds. A party or individual who brings a successful Medicare suit receives as an award, a share in any money recovered. Quit tam cases are brought under the False Claims Act, 31 USC § 3730(h) which protects private sector employees who assist in False Claims Act litigation in the Federal courts.
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