Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes.
Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments.
The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs.
The FBI investigates these crimes in partnership with:
- Federal, state, and local agencies
- Healthcare Fraud Prevention Partnership
- Insurance groups such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units
Common Types of Health Care Fraud
Fraud Committed by Medical Providers
- Double billing: Submitting multiple claims for the same service
- Phantom billing: Billing for a service visit or supplies the patient never received
- Unbundling: Submitting multiple bills for the same service
- Upcoding: Billing for a more expensive service than the patient actually received
Fraud Committed by Patients and Other Individuals
- Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
- Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance
- Impersonating a health care professional: Providing or billing for health services or equipment without a license
Fraud Involving Prescriptions
- Forgery: Creating or using forged prescriptions
- Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication
- Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices
Tips for Avoiding Health Care Fraud
- Protect your health insurance information. Treat it like a credit card. Don’t give it to others to use, and be mindful when using it at the doctor’s office or pharmacy.
- Beware of “free” services. If you’re asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged to your insurance company.
- Check your explanation of benefits (EOB) regularly. Make sure the dates, locations, and services billed match what you actually received. If there’s a concern, contact your health insurance provider.
Prescription Medication Abuse
Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. But the greatest cost is a human one—tens of thousands of lives are lost to addiction each year. Protect yourself and your loved ones by following this guidance:
- If you are taking opioids, take them exactly as prescribed by your doctor, ideally, for the shortest amount of time possible.
- Never share your medication with others.
- Explore non-opioid options with your doctor.
- Learn more about the risks of opioid use from the CDC.
- If you have unused or expired pain medications, take them to a DEA-approved take back site for disposal.