Common types of healthcare fraud

Fraud committed by medical providers

• double billing: submitting multiple claims for the same service
• phantom billing: billing for a service visit or supplies the patient never received
• unbundling: submitting multiple bills for the same service
• upcoding: billing for a more expensive service than the patient actually received

Fraud committed by patients and other individuals

• bogus marketing: convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
• identity theft/identity swapping: using another person’s health insurance or allowing another person to use your insurance
• impersonating a health care professional: providing or billing for health services or equipment without a 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

Protect yourself

• Protect your health insurance information. Treat it like a credit card. Don't give it to others to use, and be mindful when using it at the doctor’s office or pharmacy.
• Beware of free services. If you're asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged to your insurance company.
• Check your explanation of benefits (EOB) regularly. Make sure the dates, locations, and services billed match what you actually received. If there’s a concern, contact your health insurance provider.

Prescription medication abuse

Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. But the greatest cost is a human one—tens of thousands of lives are lost to addiction each year. Protect yourself and your loved ones by following this guidance:

• If you are taking opioids, take them exactly as prescribed by your doctor and, ideally, for the shortest amount of time possible.
• Never share your medication with others.
• Explore non-opioid options with your doctor.
• Learn more about the risks of opioid use from the CDC.
• If you have unused or expired pain medications, take them to a DEA-approved take back site for disposal.