How to Identify and Report Fraud and Abuse In Medical Billing and Coding

Fight Medical Fraud How to Identify and Report Fraud and Abuse In Medical Billing and Coding

How to Identify and Report Fraud and Abuse In Medical Billing and Coding

The price of provider fraud and medical billing code errors is tremendous. In 2020, American taxpayers paid for more than $130 billion in fraud and abuse in medical billing and coding through the federal Medicare program alone.

Those numbers don't include fraud and abuse in medical coding in the private insurance market, which includes group health insurance plans you get through employment. The National Health Care Anti-Fraud Association estimates it totals about $68 billion annually.

Between the two — government-funded and private health insurance — Americans are paying $200 billion every year in fluffed-up claims. But you don't need to put up with that. DoNotPay makes it easy to report fraudulent medical bills, take providers to small claims court, fight back against the most prominent hospitals, and take control of your credit.

Fraud in Medical Billing and Coding Explained

First, let's acknowledge that accidents do happen. While there can be healthcare fraud, there can also be genuine errors on medical bills. Sometimes you can fix an error on your medical bill with a quick phone call to hospital administration.

  • From the administrator's view, the challenge is that medical billing services are usually contractors who work from home.
  • They might be flaky about admitting an error or fixing it.
  • It's a massive hassle for hospitals to deal with the medical billing and coding by themselves, and they might not be able to nail down a contractor that leaves town or doesn't return their calls.

If this happens, make a few phone calls and attempt to get the bill fixed. If you don't get anywhere after a few months, use the DoNotPay Sue Now product.

But there is a more sinister side, which happens when providers fluff up the bills with upcoding or unbundling.

Upcoding Fraud in Medical Billing and Coding

Upcoding happens when providers charge your health insurer for more expensive services than you received. For example, if you had a single X-ray, but your provider charges your insurance for four X-rays, that's upcoding.

Unbundling Fraud

Unbundling happens when some services are billed individually rather than as a set. For example, your 24-hour stay in a hospital room counts as one day. A hospital can charge for things like:

  1. Meals
  2. Cable TV
  3. Cell service
  4. A landline
  5. Nursing care
  6. Various machines
  7. Ringers solution (the clear liquid in an IV)

The hospital will make more by billing for these items individually rather than as bundled services provided for a single day. 

Unbundling Fraud

Unbundling is a medical fraud similar to upcoding. In a nutshell, if you stayed in a hospital for two hours and then left, they might charge your insurance for a full day, including all of the services we listed above.

The bottom line is that you must pay close attention to your medical bills and benefits statements. When you see an error, make some noise! DoNotPay can help.

Identity Theft

You mustn't share your Medicare benefits number or private insurance account number with anyone. If you get a bill for services you know nothing about, you need to call your insurer immediately. You shouldn't be responsible for any copays, and this shouldn't go on your medical care records. Please take this seriously, and get it fixed with DoNotPay.

How to Report Medical Billing Fraud on Your Own

If you suspect Medicare fraud, it is imperative to report it immediately.

Medicare OfficeReport Online
Original Medicare
  • Call 1-800-MEDICARE (1-800-633-4227)
Medicare Advantage Plan or Medicare drug plan
  • 1-800-MEDICARE (1-800-633-4227) or
  • The Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379) or
  • Mail a complaint to:

Qlarant, 28464 Marlboro Avenue

Easton, MD 21601 Attn: I-MEDIC

FBIFBI - Tips

Get Your Medical Bills Corrected Using DoNotPay

CPT codes are the codes medical billers use to communicate costs between providers and insurers. A simple data entry error can cost taxpayers thousands of extra dollars. You don't need to put up with that kind of fraud and abuse in medical billing and codingStand up to the biggest hospital with DoNotPay.

DoNotPay has you covered in 5 easy steps:

  1. Search Fight Medical Fraud on DoNotPay.

     

  2. Tell us the date of your visit, what you were treated for, and where you were treated.

     

  3. Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code.

     

  4. Choose the correct CPT code or let us know if you want us to find it for you.

     

  5. And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction.

     

That's all you need to do. Now relax while the world's first lawyer takes on your problem.

Other Ways to Use DoNotPay

DoNotPay was created to help consumers tackle legal issues. Whenever you believe a big organization is taking advantage of you, search DoNotPay for a solution. We can help you:

Join us today to find the correct CPT codes to your medical bill and request corrections!

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