What Is Healthcare Fraud and How Can You Spot It? July 10, 2017

Health care fraud is a type of fraud involving the use of the health care system by an individual, medical provider or insurance company in a deceitful manner in order to profit from it. health care fraud influences insurance rates every day, therefore causing premiums that individuals pay to rise to cover the insurance companies’ losses. the laws regarding health care fraud vary by jurisdiction though both state and federal laws are in place to curtail and punish this crime.

Types of health care fraud

because the individuals, medical providers and insurance companies commit fraud, there are many types of health care fraud. however, the primary goal of such fraud is to profit financially or even to obtain medical care without valid insurance. the following are various types of health care fraud;

  1. fraud committed by medical providers
  2. i) Billing for services and procedures that were not provided to the patient
  3. ii) Duplicate submission of a claim for the same service when it was only performed once

iii) Billing for a different and more costly service than the one rendered

  1. iv) Billing each step of a procedure as if it was separate procedure
  2. v) Providing a service that is not covered under a patient’s insurance policy then billing for a service that is covered. check more here 
  3. Fraud committed by individuals
  4. i) Using insurance that belongs to someone else
  5. ii) Failing to remove someone no longer eligible for a policy

iii) Visiting different doctors to obtain multiple prescriptions

  1. iv) Exaggerating a claim
  2. v) Providing false information in order to receive medical coverage.
  3. Fraud committed by companies
  4. i) Collecting premiums for policies on which they do not intend to pay
  5. ii) Evading state insurance regulations to sell health care insurance they are not licensed to sell

iii) Denying payment on services, procedures or even prescriptions that should be covered.


  1. i) Patients can look for fraud by paying close attention to their bills and also reporting discrepancies to the authorities. However, if you notice that a doctor billed you for significantly more time than they spent with you, it could be a sign of fraud. Also, if they charge for services that you never received that could indicate fraudulent activity.
  2. ii) Do not accept medical advice unquestioningly. This is whereby, when there is a fraud, the party involved may try to persuade you to get tests or treatments you do not need, while the vast majority of healthcare professionals are trustworthy, you should also need to be your own best advocate.

iii) Staying alerted at the doctor’s office. When in doubt, most of us turn to our doctors, however, though it is rare for the healthcare providers to sometimes be the ones who are perpetrating fraud. Therefore, fraud of this kind may follow several forms as;

  1. a) Being charged for a service you did not receive
  2. b) Being charged for a service that is more expensive than the ones you received
  3. c) Being charged for the same thing twice

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