CFE-Financial-Transactions-and-Fraud-Schemes Exam Dumps | Mario performs surgery on a patient to replace a bone. The surgery should be billed using one code, but

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Certified Fraud Examiner - Financial Transactions and Fraud Schemes Exam
ACFE.CFE-Financial-Transactions-and-Fraud-Schemes.v2026-03-23.q111
Question 45

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Question 45/111

Mario performs surgery on a patient to replace a bone. The surgery should be billed using one code, but Mario bills the surgery using three codes (one for the entire surgery, one for the removal of the bone, and another for the insertion of the artificial bone), which increases the cost. Which of the following BEST describes Mario's scheme?

A. Fictitious services

B. False diagnosis

C. Upcoding

D. Unbundling

Correct Answer: D

Detailed Explanation:
* Rationale for Correct Answer:This is unbundling, where services that should be billed under a single comprehensive code are split into multiple components to inflate reimbursement.
* Analysis of Incorrect Options:
* A. Fictitious services - Charging for services not performed.
* B. False diagnosis - Fabricating diagnoses to justify billing.
* C. Upcoding - Billing for more expensive services than provided.
* Key Concept: Health care billing fraud - unbundling.
Reference: ACFE Fraud Examiners Manual (2020), Fraudulent Disbursements: Health Care Billing Schemes
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