Health Care Fraud or Health Insurance Fraud

Health Care Professional in Handcuffs

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.

Tips for Avoiding Health Care Fraud or Health Insurance Fraud

  • Never sign blank insurance claim forms.
  • Never give blanket authorization to a medical provider to bill for services rendered.
  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
  • Do not do business with door-to-door or telephone salespeople who tell you that medical services or equipment are free.
  • Give your insurance/Medicare identification only to those who have provided you with medical services.
  • Keep accurate records of all health care appointments.
  • Know if your physician ordered equipment for you.
  • Do not open spam e-mail, Internet advertisements, links in forums or social media, and questionable websites that promise health care-related goods or services that seem too good to be true, as they likely are fraudulent.