A medical provider billed for a name-brand drug while providing the patient with a generic version. This inflated billing scheme is known as which of the following?

• A. Undercharging
• B. Unbundling
• C. Upcoding
• D. Replacement fraud

Answer: (C)

Upcoding occurs when a provider bills for a more expensive drug or service than what was actually provided to inflate reimbursement. Here, the patient received a generic drug but was billed as if a brand-name version was dispensed, boosting the charge. This is a form of health care fraud because it knowingly misrepresents what was given to obtain higher payment. The other terms don’t fit: undercharging would mean billing less, unbundling screens charges that should be one package to extract more money, and replacement fraud isn’t the standard term used for this scenario.