Health Care Fraud or Health Insurance Fraud
Health care-related schemes attempt to defraud private or government health care programs, which usually involve health care providers, companies, or individuals. These schemes may include offers for (fake) insurance cards; health insurance marketplace assistance; stolen health information; or medications, supplements, weight loss products, or pill mill practices.
The FBI seeks to identify and pursue investigations against the most egregious offenders involved in health care fraud through its investigative partnerships with federal, state, and local agencies, as well as its relationships with private insurance national groups, associations, and investigative units. Listed below are some of the most common health care fraud and health insurance fraud scams that the Bureau investigates, as well as tips to help prevent you from being victimized.
Common Fraud Schemes
Medical Equipment Fraud: Equipment manufacturers offer “free” products to individuals. Insurers are then charged for products that were not needed and/or may not have been delivered.
“Rolling Lab” Schemes: Unnecessary and sometimes fake tests are given to individuals at health clubs, retirement homes, or shopping malls and billed to insurance companies or Medicare.
Services Not Performed: Customers or providers bill insurers for services never rendered by changing bills or submitting fake ones.
Medicare Fraud: Medicare fraud can take the form of any of the health insurance frauds described above. Senior citizens are frequent targets of Medicare schemes, especially by medical equipment manufacturers who offer seniors free medical products in exchange for their Medicare numbers. Because a physician has to sign a form certifying that equipment or testing is needed before Medicare pays for it, con artists fake signatures or bribe corrupt doctors to sign the forms. Once a signature is in place, the manufacturers bill Medicare for merchandise or service that was not needed or was not ordered.