Mental Health Northern Kentucky University Proctored Exam 7
A psychiatric-mental health nurse practitioner in private practice frequently codes for 30 minutes of psychotherapy for clients with whom she only spent 5 minutes on a medication recheck. What type of fraud is this?
Explanation & Rationale
Choice A reason: The practice constitutes fraud because billing does not reflect actual service provided, so stating it does not is incorrect. Choice B reason: Upcoding occurs when a provider bills for a higher-level service than was actually provided, as in coding 30 minutes of psychotherapy when only 5 minutes of service occurred. Choice C reason: Unbundling involves separating components of a service to increase reimbursement, which does not accurately describe this scenario. Choice D reason: QuiTam refers to whistleblower lawsuits under the False Claims Act, not the type of billing fraud itself.
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