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Federal Healthcare Fraud Schemes: Unbundling

If you have been charged with a federal healthcare unbundling allegation, you are likely facing a very trying time in addition to some very serious penalties that include possible prison time, substantial fines, and the loss of your career.

Having an experienced Maryland federal healthcare fraud attorney by your side who understand how healthcare fraud works can help you to create a strong defense. Call today to learn more.

Should You Work with a Federal Defense Attorney?

The penalties associated with healthcare fraud are very serious.  An experienced federal healthcare unbundling lawyer can help build a strong defense that might put you in a position to receive a positive result in your case.

You should contact our firm immediately if you are currently facing an allegation of federal healthcare unbundling and would like to consult with an experienced Federal unbundling lawyer. We can work with you to ensure your issue is addressed in a timely fashion.

Why is Federal Healthcare Unbundling Considered a Crime?

Sometimes referred to as “fragmentation,” unbundling is a form of healthcare fraud associated with the submission for reimbursement of medical bills related to procedures and/or tests in a separate, à la carte, fashion rather than together at one time, with the goal of maximizing reimbursement funds.

Generally, when Medicare and Medicaid are billed for medical services, a series of numerical codes are used to discern which procedures or tests are being billed.  Because Medicare and Medicaid have different reimbursement rates that are dependent upon the number of procedures grouped together, some healthcare providers submit the codes separately in an effort to generate higher fees.

What Happens to Someone Convicted of Unbundling?

Two sections of Chapter 18 of the U.S. Code explain how a person can be in violation of unbundling, and further the penalties the person may face. If a person knowingly and willingly, tried to or successfully defrauded a healthcare benefit program then he or she could be in violation of Section 1347. Depending what happens as a result of the fraud, a person in violation can face a hefty fine or a prison sentence.

Section 1035 applies to a person who falsifies a statement in a health care benefits payment document. Violation of this section of the code can lead to fines and imprisonment up to five years.

Hire Experienced Legal Representation Today

There is no substitute for experience when you’re facing federal prosecutors and investigators and the possibility of harsh penalties. Fortunately, the Maryland federal practice group at our firm provides clients with a level of care and litigation experience that can help put your mind at ease even during difficult times.

Contact our Maryland law offices as soon as possible to speak with our legal team about how we can help you.