Health insurance is necessary for many people. Although the price can be expensive, it’s essential to have insurance, especially when you visit the doctor on a regular basis. Health insurance can be a lifesaver, but there are also many ways you can be scammed. 

Unfortunately, health insurance fraud is more common than you might think. Health insurance fraud schemes range from billing fraud to treatment fraud, and much more! If you don’t know what to look for or how to catch fraud in health insurance, then you could be left paying for something you shouldn’t.

Don’t become a victim of health insurance fraud! How can you protect yourself against the different types of health insurance fraud? Start by reading the guide below and understanding what to be on the lookout for!

1. Medical Identity Theft

Medical identity theft doesn’t affect your personal finances. Instead, this type of identity theft targets your medical information in order to receive health coverage under your name. This can happen if someone takes someone else’s Medicaid or medicare card and presents it to the doctor as their own. 

When a friend uses someone’s insurance card to receive health care, this is also considered medical identity theft and fraud, even if you allow it. If this were to happen, the victim (or person who’s actually covered under the insurance policy) will become responsible for the medical bills. This is why you shouldn’t let anyone use your insurance to receive healthcare. 

To learn more information about medicare, be sure to check out the guide to original medicare and know what’s covered and what’s not. 

2. Medical Billing Fraud

Fraudulent billing is one of the more common types of insurance fraud. This happens when a medical facility or even when a doctor bills a patient for services or treatment that the patient didn’t receive. Medical billing fraud also happens when other types of errors occur on a medical bill. 

The medical bill is then sent out to the insurance company and the insurance then covers the treatments or services listed on the bill. To prevent this from happening, it’s important that you look over each medical bill and statement. You should receive a statement in the mail from your insurance company asking you to verify the treatments and services listed on the bill. 

Make sure you know what each listed item is. If you’re unsure of something, then give the medical facility or doctor’s office a call and question it. 

3. Unbundling of Services

Unbundling of services happens when a doctor bills you for various services that are all covered under one billing code. Instead of billing you for the services using the one billing code, they’ll bill you for each service separately. For example, if you were to visit the doctor to have skin cancer removed, they might bill you for the initial visit and exam, then for administering numbing medication, then for actually removing it, and so on. 

When you’re billed for each service separately, it cost more than when billed for it as a bundle. Be on the lookout for medical bills that charge you for each small medical service. This could be medical fraud. 

Also, keep in mind that incorrect coding on your medical bill is considered medical fraud as well. Some doctors will put in the wrong codes in order to charge more for the services or treatment. Look over your medical statement. 

If you see a code that’s unfamiliar or more expensive than what your services should be, then don’t hesitate to question it.  

4. Erroneous Treating 

Erroneous treating happens when a doctor treats the patient for someone they don’t have. Why would a doctor give unnecessary treatment to a patient? They can then send the bill off to the insurance company and get paid for it. 

Another way this can happen is when a doctor gives a patient a referral to see a specialist when it’s not needed. They do this because some doctors are paid for sending referrals. Erroneous treating also includes doctors sending bills to insurance companies for treatments never performed. 

If you want to prevent this from happening, you should get a second opinion. If both doctors suggest you see a specialist or suggest a specific type of treatment, then there’s a smaller chance of it being medical fraud. 

5. Unnecessary Procedures

When a doctor charges a patient or the insurance company for services or treatment that’s not needed, this is also considered medical fraud. Sometimes, this refers to cosmetic procedures. Cosmetic procedures aren’t medically necessary and most insurance policies won’t cover them.

To get around this, doctors will claim the patient needs the cosmetic procedure for various untrue reasons. Because of this, many insurance companies will require you to get a second opinion. They also look closely over the reasons for the cosmetic procedure, making it more difficult to get away with.  

Protect Yourself Against Health Insurance Fraud

Health insurance fraud happens more often than you might think. When medical fraud takes place, it raises your health insurance costs and can land the person in jail with a large fine. Because of this, you want to avoid engaging in medical fraud. 

Use the information given above to help stay on top of your health insurance and medical bills. If you believe health insurance fraud has taken place, then be sure to report it to your health insurance as soon as possible. 

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