9 Ways Your Health Care Provider Might Be Committing Fraud (and Costing You Money)

INSURANCE
Is it a billing mistake or a deliberate action to take your money?
Updated Feb. 21, 2024
Fact checked
Couple with doctor

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Are you paying attention to your medical bills? If not, your provider might be costing you money and committing fraud in the process. 

Regardless of your medical coverage (or lack thereof), it’s important to keep an eye on bills. The last thing you need is to be overcharged or have your insurance provider decline your legitimate claims.

You might be able to keep more money in your wallet if you're able to understand these 9 things that your provider might be doing wrong, whether they know they are doing it wrong or not. 

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Billing for services not performed

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Whether you schedule a routine appointment or an appointment for a new issue that needs to be addressed, billing errors may occur.

If your bill seems to have some extra charges for items or services you didn’t receive, it could be just an oversight, or it could be a sign of fraud.

Keep an eye on your bills. If you notice a charge for something you didn't receive, contact your healthcare provider and insurance company. 


Double billing

insta_photos/Adobe female accounting analyst checking bills

You may get a bill in the mail and think it’s strange — because, well, you already paid that bill. Your health care provider may be trying to trick you into paying too much for services.

Check your bank account or credit card statement to make sure the bill isn't a duplicate. Keep copies of your bills handy for the same reason.

Upcoding

Andrey Popov/Adobe medical coding

Medical bills are confusing, and you probably wonder what all those codes are related to your treatment.

But take a closer look if you can to see if the description matches the service you were provided. Is the price higher than for similar services you had in the past with that provider?

Your provider may have upcoded you, which means they used a different code to charge you a higher price than what you should’ve been charged. So talk to your insurance company to see if they can help you determine if your charges were upcoded.

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Waived deductible or co-pay

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You may think you got lucky because you found a provider who waives your deductible or co-pay.

The provider, however, could be overcharging your insurance company to cover the deductible you didn’t pay in order to encourage you to continue visiting.

Be careful about your responsibility in these cases, as you may have to pay a deductible later on if your provider gets caught.

Billed without seeing a provider

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Are you getting bills that show charges to your insurance company even though you never saw that provider?

You may have had your identity stolen for fraudsters to make fake claims in your name. In addition to checking with your insurance company, you’ll also want to review your credit report. 

If your identity was stolen, look into freezing your credit or using a service to check for other identity theft issues that could be affecting you.

Covering a non-covered service

Prostock-studio/Adobe Patient talking to doctor during appointment.

Sometimes, a physician provides you with a service that they can't bill your insurance for.

For example, they may be prescribing you medicine that isn't approved for your particular issue or giving you an experimental treatment. But they could be billing your insurance company for something else in order to cover your treatment.

Make sure the treatment you are receiving is reflected in the paperwork your provider is filing with your insurance company, or you could end up losing cash.

Kickbacks

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Rather than taking money from you, kickbacks involve giving you money if you use a particular doctor, pharmacy, or lab.

You may think it’s a great deal until you get the bill and realize it's more expensive than if you shopped around to find the best care and best deals on your own.

Double visits

Pixel-Shot/Adobe patients waiting in hall of clinic

Some health care providers may charge you or your insurance company on a per-visit basis.

Your provider may be committing fraud, however, if they try to break your office visit into more than one appointment in order to charge the insurance company for two office days.

Check your bills and keep track of the dates you see your doctor to make sure those dates are properly represented on your bill.

Incorrect location

Clayton D/peopleimages.com/Adobe woman with healthcare medicine

You might take a prescribed medicine once a week. Or perhaps you have tests done at a lab on a regular basis.

Keep an eye on your bills. Your provider may try to charge you for that weekly prescription (which you take at home!) or your visits to the lab as if they were office visits.

You could lose money paying for co-pays, deductibles, or office visits when you never went into the office.

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Bottom line

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While the majority of healthcare providers are honest, you should keep track of their charges just as you would for any service. There could be issues you'd never notice until you dig down.

Medical care is expensive enough as it is. Monitoring your bills can help you avoid throwing money away.

Check with your insurance provider if you fear you may be getting scammed. They could help you find the scam or may even recoup the money the scammer tried to take.


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Author Details

Jenny Cohen Jenny Cohen is a freelance writer who has covered a bit of everything, from finance to sports to her favorite TV shows. Her work has been featured in The Wall Street Journal, USA Today, and FoxSports.com.

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