Common Health Fraud Scams in the US

By Your Health Magazine

The healthcare sector has not been immune to the rising wave of scams that plagues governments, industries, and consumers alike.

Criminals devise various healthcare frauds each year to steal billions of dollars in the US. But the government, healthcare providers, and insurance companies are not the only ones shouldering this cost. As a taxpayer, you pay for much of what is stolen from Medicare and Medicaid. In addition to this, you can get affected in numerous ways, both financially and otherwise—from maxed-out insurance policies to health threats arising from data manipulation. These days, there’s a lot that public records reveal about you. But some information, such as your health insurance number, SSN, and billing statements, should never be shared with others.

In this article, we unravel the common health scams you must guard against and what you can do to prevent or mitigate them.

Common Health Scams

Here is our list of the top four health frauds affecting Americans of all ages.

1. False Billing

This usually happens from the medical service providers’ side when they submit misleading claims to federal or private health insurers.

For instance, they may bill for treatments or drugs you have not obtained or indicate ones that are more expensive than what you received.

Unbundling is also common. It involves breaking down the cost of a treatment into smaller chunks. This allows healthcare providers to create a distraction to include services not rendered.

They can also send two separate bills for the same treatment, a practice known as double-billing.

At first glance, the impact of all these may seem to be on the health insurance provider, whether it is the government or a private company. However, there is an indirect cost to you, too.

Fraudulent billing practices eat into your health insurance benefits. In the end, when your plan is maxed out, you will have to pay out of your pocket for medical expenses during the remainder of the year.

The easiest way to avoid this type of health fraud is by reviewing the explanation of benefits (EOB) your health insurance provider sends. Keep records of all medical services or treatments you receive and check them against those listed on your EOB.

If you notice any discrepancy, immediately notify your insurer and request an investigation.

2. Identity Theft

Did you know your healthcare details are part of your personally identifiable information (PII)? Patient registration records and medical insurance data can all put you at risk in innumerable ways when compromised.

For example, your patient registration information can provide criminals with access to all your medical history, allowing them to purchase drugs using your prescriptions or receive treatments under your name.

With your health insurance ID, they can make fraudulent claims for treatments you have not obtained and, eventually, use up your insurance benefits.

The repercussions of identity scams can get worse when criminals obtain treatment by assuming your identity. This can lead to inaccurate health records getting added to your files. As a result, you could receive the wrong treatments during a medical emergency, which may threaten your long-term health and even your life.

How can someone steal your medical identity? A criminal impersonating your insurance provider can call and ask you to confirm your insurance information. Scammers can also pose as your healthcare provider and attempt to access your identifiable data.

Sometimes, identity theft can occur due to data breaches. For example, an employee at your medical service provider can secretly gain access to patient records, which they can later use to commit healthcare fraud or sell to a criminal.

Hacking attacks are also prevalent. The recent breach at HCA is a good example.

While there is little you can do to prevent a hacking threat at a third-party organization, there are certain steps you can take to minimize or prevent many identity-related scams.

Here’s what we recommend:

Safeguard your healthcare information. Keep digital files password-protected and secure devices with anti-virus software. Store printed documents in a safe location and use a shredder when you need to dispose of them.
Only share health-related data after assessing the requirement.
Verify the source when you receive a request for personal information.

3. Fraudulent Product Promotions

Promotions containing falsified or misleading information are more common in healthcare than in many other industries. These can target individuals with critical diseases as well as those looking to achieve overall fitness, well-being, and cosmetic care.

For instance, scammers can offer fake medical plans to steal your credit card information or medical identity-related data. Or, they can promote miracle cures for diabetes, secret formulas to lose weight, or natural remedies to look ten years younger. Some may also sell inferior-quality drugs under popular brand names.

Apart from the risk of stealing your money and data, these scams could potentially put your life at risk, too. So, be vigilant about any product or treatment plan that promises quick fixes or seems too good to be true. Be particularly wary of vague claims and promises.

Always check and review information before purchasing or subscribing to products or services and ensure they are scientifically backed.

4. Kickbacks

Medical businesses often encourage healthcare providers to promote their products, equipment, and services by offering money and gifts.

These kickbacks can jeopardize your health when healthcare professionals prescribe risky treatments and unnecessary drugs that don’t benefit you in any way. You can’t ignore the financial impact either, especially when your medical insurance policy is used up for healthcare you don’t really need.

To avoid such incidents, take a keen interest in your health and ask questions from your healthcare provider to understand what treatments and procedures are required and why. In addition, doing your own research and getting a second opinion could be useful when it comes to long-term or serious medical conditions.

To Conclude

Health scams are becoming increasingly prevalent and can pose numerous threats to you as a patient. They can compromise your privacy and identity, target you for direct and indirect financial fraud, and even place your health at risk.

False billing, medical identity theft, fraudulent product and service promotions, and kickbacks are the most common scams to keep an eye on. Practice caution, remain vigilant, and take effective steps to minimize their advances and ensure your safety.