Many Faces of Fraud: Medical Insurance Fraud, Part I

Many Faces of Fraud: Medical Insurance Fraud, Part I

by Angela Bass, March 17, 2016

Most individuals committing medical insurance fraud are well aware of how their shady antics will pay off if their schemes succeed. The possibility of getting caught is a mere afterthought. But medical insurance fraud is sometimes carried out on a massive scale by insurance companies, hospitals, employees and patients. All cases of fraud on small and large scales cost Americans billions of dollars every year, and it is vital that you learn how to recognize the many faces of fraud.

Medicare, Medicaid and other taxpayer-funded programs are among the largest and easiest programs for scammers to target, making medical fraud one of America’s biggest taxpayer ripoffs.

The many faces of medical fraud

Knowing what medical insurance scams are can keep you from becoming someone’s next victim.

Phantom treatments
Shady medical providers will bill health insurers for costly treatments, exams or equipment that you never actually received. They’ll also bill you for diseases or injuries you don’t have.

Double billing
Unethical providers may double- or even triple-bill health insurers for the same treatments. Their hope is that the insurer won’t discover the duplicate in their big pile of bills.

Shoddy care
You could receive shoddy or substandard treatment for real and urgent medical problems. An eye doctor can shine a small flashlight into your eyes and call it ‘cataract surgery.’

Unnecessary care
You might receive dangerous or life-threatening treatments you don’t need. A surgeon based in Redding, CA performed 82 medically unnecessary heart surgeries, leading to nine deaths.

Bogus insurers
Insurance agents or brokers sell you cheap health coverage from a made-up insurance company. Then they disappear with your premiums. You don’t know it until you make a claim.

Identity theft
Fraudsters steal your medical ID number, then use it to bill for fake treatments. Crooks can steal your health info from a hospital’s dumpster, break into doctors’ offices and hack into online files.

Rolling labs
Mobile diagnostic labs give needless tests or bogus physical exams to consumers, then bill health insurers for expensive procedures. And then they skip town to avoid the consequences.

A person hired by a medical provider to drum up business trolls through communities, often low-income areas, luring or even guilting people into a clinic for tests.

By knowing this information, you will be less likely to become a victim of a medical insurance scam. Stay aware. Stay informed. Stay safe. Don’t forget to subscribe to the Asurea Scam Report email update list for more informational tips such as this. The subscription box is located just to your right!


For more articles on insurance scams:

10 signs that you are the target of health insurance scam.

3 quick tips to avoid insurance scams.



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This information is provided for general consumer educational purposes only and is not intended to provide legal, tax or investment advice.


Angela Bass

Angela Bass

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Angela joined Asurea as the Content Marketing Writer in September 2015. She is also a freelance multimedia journalist, having written and produced stories for Land & People Magazine, The Baltimore Sun, California Health Report, NPR's Latino USA, PRI's The World and KALW's Crosscurrents, among others. In 2014, she founded Storybrook Media, which provides video production services to nonprofits and small businesses. She holds a Master’s in Journalism from UC Berkeley and a BA in Creative Writing from San Francisco State.
Angela Bass