Preventing Medical Billing Fraud—Everything You Should Know

Fight Medical Fraud Preventing Medical Billing Fraud—Everything You Should Know

Preventing Medical Billing Fraud—Everything You Should Know

Health insurance is crucial for helping millions of U.S. citizens pay for essential doctor's visits, surgeries, and prescriptions. This means that many people will do everything to learn about preventing medical billing fraud. A common example is when healthcare providers claim that your required healthcare services cost more than they did.

Patients, government agencies, and insurance providers lose $68 billion per year as a result of medical fraud. This practice is illegal and should be reported to your healthcare provider (or higher authorities) immediately. If you suspect that you've been subjected to healthcare fraud, DoNotPay can help you address it.

Different Types of Healthcare Fraud

These are the most common inaccuracies that are found on medical bills:

  • Phantom billing: In this instance, healthcare providers will try to bill you for services that you never received in the first place.
  • Upcoding: This is when a medical provider assigns a higher CPT code to your case. Upcoding makes your treatment appear more complex in an attempt to extort more money from you and your insurance provider.
  • Unbundling: This is when procedures usually covered by one CPT code are split apart into separate charges. While this practice is sometimes permissible under bundling guidelines, it's more often done intentionally to receive extra payment.
  • Double billing: This is when healthcare providers will bill you multiple times for one service.

Tips for Preventing Medical Billing Fraud on Your Own

Any healthcare provider is capable of committing medical billing fraud, even if you've been a patient for years. Here are some techniques for avoiding fraudulent charges:

Review Your Explanation of BenefitsYour EOB will outline the treatment services and medical equipment covered under your insurance plan. Be sure to regularly review this statement for any changes.
Avoid Blanket AuthorizationsNever sign a paper that allows a doctor to bill you for any services that they are willing to provide. Unless you wish to pay out-of-pocket, you should only receive treatment that is covered by your insurance.
Protect Your Health Insurance InformationYour medical insurance card should only be shared with a trusted healthcare provider. Don't use it to pay for services online unless instructed by your doctor.  Contact your insurance provider immediately if your card is lost or stolen.
Don't Sign Blank FormsBlank or incomplete insurance claims forms should never be authorized with your signature. Healthcare providers can modify the document afterward to increase the cost of your treatment or add on extra services without your consent.
Ask for Itemized BillsWhenever you receive treatment, ask for your receipt that lists an individual charge for each service rendered. This discourages healthcare providers from upcharging you or listing services that never occurred. Itemized bills can also serve as good evidence in small claims court.
Avoid Suspicious PracticesNever purchase medical equipment or services from door-to-door salespeople, especially ones that don't provide any credentials. Also, be wary of any doctor that tries to give you "free" treatment: you will likely be charged later.

Even if you take great caution to prevent medical billing fraud, shady healthcare providers can still take advantage of you. When this happens, you'll need to contact your medical provider immediately and ask what CPT code was used for your treatment. If it was a mistake, they should be able to correct it and give you a new billing statement.

If the healthcare provider in question won't cooperate with your request, you should report them to the proper authorities. These might include:

  • The HHS-OIG
  • The city- or county-specific DOH in your state
  • CMS

There are multiple ways you can submit your complaint:

  1. Calling the hotline listed on the specific agency's website
  2. Contacting an agency by mail
  3. If possible, submit the complaint via an online form

Doing all of this on your own can be exhausting, especially if you're already stressed about an unfair medical bill. The good news is that DoNotPay has an easier way to fix the problem.

Report Medical Billing Fraud Instantly Using DoNotPay

DoNotPay has an easy-to-use solution that automatically finds medical billing fraud on your behalf. It can feel near impossible to locate the matching CPT code for your case, but this product will help you through the process. If you don't receive a satisfactory result from your healthcare provider, you can use the Sue Now product to file a small claims lawsuit.

If you want to write a demand letter for medical 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.


DoNotPay is the best way to protect yourself from medical billing fraud because:

  1. A demand letter prompts a quick response from most corporations
  2. It's easier than researching CPT codes and fighting for information from your physician without help
  3. DoNotPay always has your best interests in mind as we fight for your case, guaranteeing better outcomes

DoNotPay Helps Prevent Healthcare Billing Fraud From Any Entity

Medical billing isn't a crime limited to just healthcare professionals. Individuals can claim to be healthcare providers with no medical training. Doctors can also be charged with medical billing fraud if they perform services (and subsequently bill you) without a license. Regardless of the situation, DoNotPay knows how to handle it. We can also help you address the following:

Use DoNotPay to Report Other Illegal Activities

Aside from preventing medical billing fraud, DoNotPay can also be used for preventing:

Join DoNotPay today to prevent medical billing frauds from happening to you!

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