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What are the common types of health care fraud?

Written by Admin
Posted On January 06, 2024

According to the US Federal Bureau of Investigation (FBI), the three main categories of healthcare fraud are fraud committed by medical providers, fraud committed by patients or others, and fraud involving prescriptions. Each category includes specific fraudulent activities:

Fraud Committed by Medical Providers:

  • Double billing: Submitting multiple claims for the same service.

  • Phantom billing: Submitting a bill for a service visit or supplies the patient never received.

  • Unbundling: Submitting multiple bills for the same service.

  • Upcoding: Submitting a bill for a more expensive service that the patient actually received.

Fraud Committed by Patients or Others:

  • Bogus marketing: Convincing people to provide their private information in order to steal their identity, bill for services that weren’t provided, or enroll them in a fraudulent benefit program.

  • Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use yours.

  • Impersonating a health care professional Providing or billing for health services or equipment without a medical license.

Fraud Involving Prescriptions:

  • Forgery: Creating or using forged prescriptions.

  • Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication

  • Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices

These fraudulent activities contribute to the significant financial losses within the health care system and can have adverse effects on patient care. Health care fraud investigations are crucial to identifying and prosecuting those involved in such activities.

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