Unbundling Fraud

Unbundling is a fraudulent scheme accomplished by billing several procedure codes for a group of procedures, even though the group should properly be billed under a single all-encompassing code. The sum of reimbursements for each code paid separately is higher than the reimbursement for the comprehensive code, causing an overpayment.

For example, a physician might order a panel of blood tests for a particular patient. The laboratory receiving the order commits fraud if, instead of billing for the panel, it attempts to increase its income by billing separately for each test conducted.

Examples of Unbundling Fraud:

  • Duke University: The University settled an FCA case in 2014 based on accusations its hospital billed cardiac and anesthesia services separately, resulting in higher reimbursements to which it was not entitled. The case was initially brought by a whistleblower, who had been an auditor at Duke.