Can You Get Money Back from Health Care Fraud? Here's How

Fight Medical Fraud Can You Get Money Back from Health Care Fraud? Here's How

Can You Get Money Back from Health Care Fraud?

If you or a loved one has recently had an emergency room visit or healthcare treatment, and your bill looks unusually high or suspicious, you are not alone. If you suspect any type of healthcare fraud, you should act immediately.

However, not everyone recognizes fraud by medical providers. DoNotPay has created this guide to help you understand healthcare fraud and how to respond.

What is Healthcare Fraud? 

Healthcare fraud is an attempt by companies, medical providers or individuals to defraud insurance companies or government healthcare programs. There are many different types of healthcare fraud.

Healthcare fraud can include false marketing, Medicare fraud, identity theft, impersonating a healthcare professional, forged prescriptions, medical billing fraud, and more.

Common Types of Medical Billing Healthcare Fraud 

There are several different types of fraud that can be committed by medical providers to defraud the healthcare system. Some of the most common methods include:

  • Double Billing - Double billing occurs when a provider submits multiple claims for the exact same service.
  • Phantom Billing - Phantom billing is when a provider bills for a visit, service, or supplies that the patient never received.
  • Unbundling - Unbundling is when a medical provider submits multiple bills for the same service by billing for each stage of a procedure under the pretense that they are separate procedures.
  • Upcoding - When a medical provider bills for more expensive services than the patient actually received, this is a type of fraud called upcoding.

What is CPT Upcoding? 

One of the most common forms of medical fraud is CPT upcoding. Current Procedural Terminology (CPT) is a set of medical coding which is used to report medical, diagnostic, and surgical procedures and/or services to health insurance companies, physicians, etc.

When a medical provider or entity codes your service or procedure as a higher costing CPT, it is known as upcoding. This is an attempt to defraud you, your insurance company, and/or Medicare.

Who Investigates Healthcare Fraud? 

If you find or suspect healthcare fraud, there are several places to report medical billing fraud for investigation. 

1. Private Insurance

Contact your insurance provider and request to be directed to the fraud department. They can walk you through the reporting process.

2. Medicare

There are different ways to report Medicare fraud, depending on your plan.

Original Medicare
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
  • By mail: Qlarant, 28464 Marlboro Avenue, Easton, MD 21601, Attn: I-MEDIC

3. Federal Bureau of Investigation

You can report health care fraud to the Federal Bureau of Investigation (FBI) through their Tips form.

How to Fight Healthcare Fraud on Your Own 

It is possible to deal with healthcare fraud on your own, but it can be tedious and time-consuming. It is important that you remain persistent and firm. As a patient, here are some things you can do to protect yourself and fight against healthcare fraud. 

  1. Ask Questions: Before receiving services, ask why they are necessary, what they cost, etc.
  2. Examine Paperwork: Make sure you thoroughly read and carefully fill out, sign, and date paperwork. Review and fill out claims individually.
  3. Compare Your Insurance Provider's Explanation of Benefits (EOB) and Your Bills: It's important to review your medical bills and EOB with your personal records to make sure the dates and services are accurate.
  4. Contact Your Provider: If you suspect an error or issue, contact your provider immediately to dispute the error or charges. Sometimes it is a mistake, and they can correct it. If they refuse to discuss or rectify the issue, you may need to escalate the problem.
  5. Report the Fraud: Notify Medicare of fraud or contact your insurance provider's fraud department. You should also file a report with the FBI if you believe you are a victim of healthcare fraud. Use the contact information listed above. They can walk you through the appropriate steps and help you through the issue.

Fight Upcoding Fraud the Easy Way with DoNotPay

Sometimes it can be intimidating to try to discuss billing issues, especially if your healthcare provider is uncooperative. However, DoNotPay has a practical solution for fighting upcoding fraud. We can write a demand letter for bill correction to help you through the process.

If you want to find the correct CPT code and write a demand letter for bill correction but don't know where to start, 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.

What Else Can DoNotPay Do?

In addition to helping you fight healthcare fraud, DoNotPay can solve many other problems, including: 

Join DoNotPay today to find the correct CPT code and demand a bill correction!

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