Health care fraud

What is health care fraud?

Health care fraud is a serious business in the U.S. — and a serious crime.

The variety of health care fraud is vast. Common examples include:

• Using an expired or fraudulent identification card to obtain medical services or medications
• Lending an ID card to someone who is not entitled to it
• Adding someone who is not eligible for coverage to a contract
• Providers who bill for services never rendered
• Performing medically unnecessary services to receive payment from insurers
• Billing for more expensive services or procedures than were actually provided
• Accepting kickbacks for patient referrals

If you suspect fraudulent activity, please report it immediately.

How fraud impacts you

For consumers, health care fraud adds up to higher premiums and out-of-pocket costs and reduced benefits and coverage. Fraud also hurts employers by driving up the costs of providing benefits to employees and increasing the cost of doing business.

Estimates put the amount lost to health care fraud at between 3 and 10 percent of overall health care spending — between $68 billion and $226 billion. With health care costs on the rise, the price tag for fraud is likely to climb unless efforts to combat it are successful.

And fraud carries nonfinancial implications for victims like:

• Being subjected to unnecessary or unsafe medical procedures or treatments
• Finding that your insurance benefits have unexpectedly been exhausted
• Having erroneous information added to your medical records
• Receiving the wrong medical treatment, unexpectedly failing a physical examination for employment, or being deemed uninsurable as a result of medical identity theft