Can I Recover Money From Medical Billing Scam? Here's How!

Fight Medical Fraud Can I Recover Money From Medical Billing Scam? Here's How!

Can I Recover Money From Medical Billing Scam? Here's How!

In the United States, medical bills are very expensive. Therefore, receiving a large medical bill may not seem like a big deal. The problem is that doctors can overcharge for their services. You need to know what to look for to ensure you're not a victim of a medical billing scam.

Most people do not have automatic knowledge of how much they should owe for a hospital stay or blood testing. We must trust the billing department for that hospital or that lab. This isn't always the safest thing to do because it could end up costing you much more than it should.

With DoNotPay in your corner, you can take the guesswork out. We can explain how CPT fraud or upcoding works and what you can do about it if you feel it has happened to you.

5 Common Types of Medical Billing Scams

There are several types of medical billing scams that may negatively affect you, your finances, and your insurance company. The most common are:

  1. Billing Excessively

Although it may not apply to your situation, excessive billing is a common problem. It occurs when a doctor's office bills for more patients than they could handle in a day.

  1. Wrongly Documenting Services

Falsifying documents is always wrong. However, sometimes mistakes can happen, especially when a medical facility is sending those documents to your insurance company. The insurance company may not know what services you received, so it is easy to overcharge.

  1. Wrong Service Dates, Locations, or Providers

Sometimes a doctor may charge insurance companies for multiple dates, locations, or services by simply breaking up the information differently. For instance, let's say the doctor sees someone twice in one day, but they bill for two days, so it's not combined into the one office visit.

  1. Waiving Co-payments and Deductibles

Your doctor has no right to waive co-payments or deductibles and then charge your insurance company for it. However, it happens. Although it benefits you; the office or the doctor, is not doing the right thing.

  1. Upcoding or Unbundling

The most common type of medical billing scams is associated with upcoding and unbundling. This happens when a doctor puts the wrong CPT code on the medical bill or breaks up one procedure so that you're charged for multiple parts of it.

CPT codes are not something that most of us know about. However, it is an easy way for doctors to state what services they have provided. It ensures your insurance company can know immediately what to pay out to the doctor. Errors happen, and the insurance may catch it, but if they refuse to pay, the full cost of that erroneous code could mean you have to pay more than you owe.

Know the Signs: How to Spot Medical Billing Scams

Now that you know about medical billing scams that are common, you need to know what to look for if you feel they have overcharged you. It will require you to be diligent because you must know what was done and when.

Some things to watch for are

  • Being Billed Multiple Times. If you visited the doctor and had your blood drawn for testing, that's great. However, you should know what they are testing for so that you can know if they charge you for tests that were not performed.
  • Keep Up with Your Appointment Dates. Since some billing departments may say you visited when you weren't there, you should always keep track of your appointment dates. This way, if there is a question from your insurance company, you can answer.
  • Pay Attention to Procedure Charges. Most insurance companies will tell you of charges that have been applied to your insurance. Medicare may send out a questionnaire every few months asking whether it's all things you've had done. Know what tests you've had done, procedures, and more to ensure that your insurance isn't being overcharged.

Billing departments will pass false claims to state, or government-issued insurance agencies, like Medicare. Your diligence in trying to keep up with your medical history will help to prevent it. This will protect you from losing the insurance coverage you have.

How to Report Medical Billing Scams

You may not think that Medicare fraud affects you, but it does. The more fraud there is, the fewer people may be allowed to be on it. Therefore, it is important for you to know who to contact to report it if you feel that you have been a victim of medical billing scams.

Some people to contact about your situation are

  1. Phone: (800) 447-8477 or (800) 377-4950
  2. Fax: (800) 223-8164
  3. Mail: Office of Inspector General, ATTN: OIG HOTLINE OPERATIONS, P.O. Box 23489, Washington, DC 20026

Each of these resources can help you if you feel that a medical facility has been deceitful in its billing practices. Once reported, your insurance provider will look at the CPT code and try to figure out whether upcoding was involved or not.

What Does CPT Upcoding Mean?

CPT codes are not easily understood. There are more than 7,800 codes used by healthcare providers, and they represent every possible medical procedure, condition, or drug used by doctors. No one expects you to understand them all or know what they mean.

Helping your insurance company figure out the truth behind the code is very important. Some scenarios that may happen are

Example 1 Let's say you went to your doctor as a new patient, which would be a 30-minute visit with the code 99214.The code that appears on your insurance claim though is one that ultimately charges insurance the cost of an emergency room visit. This is not acceptable.
Example 2You're in the emergency room, and they give you a full exam. It will require a code indicating you were in the ER and that they examined you, which may cost a couple of hundred dollarsThey submit a bill to Medicare with a code that indicates you had a CT scan, numerous labs, and more.

These codes may be bundled together, unbundled, and more. It is all based on what you had done while you were in the doctor's office.

How to Handle Medical Billing Scammers on Your Own?

The only real way to handle a medical bill scam is to confront it. To do this, you must first understand the CPT codes that apply to your situation. Once you know the codes and have discovered a discrepancy, you will need to contact the people listed above and/or create a demand letter requesting that the billing department explain the code to you.

A typical demand letter will include

  1. The Date
  2. A Letter Number
  3. Medical Facility Information
  4. What Was Overcharged
  5. Your Responsibility Because of Overcharge

If you are not part of the insurance company or have no legal backing, they may not acknowledge your demands. This means you will have to fight even harder to be heard. This could mean hiring a lawyer, which could cost you more than the overcharged fee.

Your other option includes letting DoNotPay handle it for you!

DoNotPay Can Help You Deal with CPT Code Medical Billing Scams

With the CPT Code Product by DoNotPay, you have a lawyer backing you from the start. This will simplify the process for you to fight back against health care fraud, while we ensure that your rights are protected fully by The False Claims Act.

By using our service, we will help you find the correct CPT codes and write a demand letter on your behalf in just five easy steps.

All you must do is

  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.


You cannot get much simpler than that. We do all the heavy lifting for you!

Why Use DoNotPay to Fight Medical Billing Scams

You have just gotten out of the hospital or the clinic and did not expect the exorbitant bill and all the codes make your head dizzy trying to know what it means. DoNotPay is the best choice because it is

  1. Fast- You do not have countless hours searching the codes that medical practitioners use to overcharge your insurance.
  2. Easy- No more tedious forms to fill out to file your complaint against unbundling or upcoding.
  3. Successful- DoNotPay will disentangle all their medical and legal jargon for you to make the truth surface and ensure that you win your case.

What Else Can DoNotPay Do?

As the world's first online robotic lawyer group, DoNotPay can handle even the most complicated situations in life. Not only can we help you with a medical billing scam, but we can also help you with requesting sick leave and creating advance healthcare directives.

DoNotPay services cover a large variety of situations. Only some of these include

To get started with our many services, all you must do is join DoNotPay online!

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