In the United States, 6% of adults face over $1,000 in medical debt, often leading to financial crises, according to a Kaiser Family Foundation analysis of the Census Bureau data. However, this reality has been even more complicated by fake medical bills, which worsen the problem by ruining people’s credit scores and leading to financial stress.
Beyond impacting people, fake medical bills can have financial repercussions for healthcare institutions, including negative impacts on trust and reputation. In this post, we’ll explore how fake medical bills work, giving you a guide to recognize them, real-life examples, and tips on how to protect yourself from falling victim to this type of fraud.
Need support after a scam? Join our community today.
What is a Fake Medical Bill?
Fake medical bills are a type of fraud involving the creation of fake bills or the manipulation of legitimate ones to charge for services that were never provided or to artificially inflate the cost of services. This scam financially affects people and interferes with their health insurance benefits. Some examples of fake medical bills are:
Overbilling
Imagine going to the doctor for a routine checkup that normally costs $150, but you receive a bill for $300. This is a classic example of overbilling, where the charge on your bill is higher than what should have been billed for the actual services provided.
Phantom Charges
Suppose you visit a hospital for a minor medical procedure, and your bill includes charges for a magnetic resonance imaging (MRI) and a series of lab tests that you never received. These are phantom charges for services that were never actually provided to you during your visit.
Upcoding
Suppose you have a minor wound treated with simple cleaning and a bandage at a clinic. However, the bill you receive lists the treatment as a complex medical cleaning that costs much more. This practice, known as upcoding, involves billing for a more expensive service than the one that was provided.
How to Identify a Fake Medical Bill?
When paying for medical services, we rarely check the bills in detail. However, when there are reports of this type of scam, it is very important to know the signs that show how a fake medical bill looks like. Here are some warning signs to watch for:
1. Fake Service Dates and Medical Provider Identities
Fake medical bills often use real medical practice logos, making them seem legitimate. To ensure accuracy, first check the date of service; if you didn’t visit a doctor on that date, it’s a warning sign. Additionally, call the contact number on the bill and ask questions to confirm its legitimacy.
2. Inconsistencies in Bill Details
Check your bill for mistakes in the letterhead, or account numbers. Fake bills might have details that look altered or falsified. If the paperwork appears unprofessional or different from previous bills from the same provider, it could be fake.
3. Additional Small Charges
Scammers may add small, subtle charges to bills, hoping they won’t be noticed. Carefully review your bill for any minor fees that seem unrelated to the services you received, or for any items that you don’t remember being part of your treatment.
How to Avoid a Fake Medical Bill?
Once you learn how to identify fake medical bills, you can start protecting yourself from becoming a victim. Here are some key indicators that can help you avoid fake medical bills:
1. Prior Authorizations and Cost Estimates
Before any treatment or diagnostic procedure, always ask for prior authorization and a detailed cost estimate from the medical center. This makes sure that you know exactly which services will be provided and how much they will cost.
Additionally, make sure you understand what your insurance will cover. This process helps you spot any unplanned charges on your final bill.
2. Matching Bills with Insurance Filings
When you receive a medical bill, always compare it to the explanation of benefits (EOB) provided by your insurance company. The EOB shows what treatments were covered and what you are expected to pay. If there are services listed on the bill that don’t match the EOB, or if there are charges for treatments you did not receive, this could be a sign of false billing.
3. Double-Billing Check
Be aware of situations where both you and your insurance might be billed for the same service. Check if the amount you are asked to pay matches what has already been covered by your insurance. Any differences here could refer to a plan to charge both parties for the same service, which is a common fraudulent practice.
The Fake Medical Bill Case of Carolyn and Elizabeth Wallace
According to the BBC, Carolyn Wallace took her four-year-old daughter, Elizabeth, to a Texas hospital after she hit her head on a coffee table. A doctor checked Elizabeth’s temperature and then left them to wait. Receiving no further care, Carolyn decided to visit another hospital, where Elizabeth was treated right away.
What Happened Next?
Although Elizabeth received minimal treatment at the first hospital, Carolyn was billed a total of $969, which included $669 for a temperature check and $300 for facility use.
In an interview with the Vox, Carolyn stated that the charges were excessive, especially since no medical supplies like gauze or cotton were provided; Elizabeth had to use the same towel Carolyn brought from home during their time there.
What are the Hospital’s Actions?
Carolyn complained about the $969 bill from the first hospital; the hospital eventually waived the $300 facility fee. However, the subcontracted company that hired the doctor insisted on payment for the temperature check.
Have questions about dealing with scams? Contact us for support.
What to Do When You Get a Fake Medical Bill?
Even when many patients stay alert, scammers are getting better at crafting personalized and seemingly legitimate scams, such as creating medical bills that look very real. If you have to deal with one, here’s what you can do:
1. Contact Healthcare Providers Directly
If a bill lists services you never received or duplicates a paid bill, contact the doctor’s office or hospital directly. Billing mistakes happen, such as outdated accounts or misidentified patients. Explain the situation and request verification. If they insist you need to pay money, and it’s incorrect, it could look like a scam and more steps are needed.
2. Contact with Insurance Companies and Relevant Hotlines
If the healthcare provider cannot resolve the issue, contact your insurance company to verify charges against your claims. Call the number on your insurance card or the relevant hotline. Reporting to your insurer prevents processing fraudulent payments and helps them monitor for similar cases, checking for extra protection against medical billing scam.
3. Involve the Consumer Financial Protection Bureau (CFPB)
If a fraudulent bill appears on your credit report, it can impact your credit score. To prevent or resolve this, contact the CFPB to complain about the charges. They can help you address the issue before it affects your credit, or assist in correcting your credit report if the charges are already listed.
Protect Yourself from Fake Medical Bills
The Better Business Bureau has reported numerous complaints about falsified medical bills, often stemming from suspicious calls or notifications. For this reason, it is important to thoroughly understand the details of a medical bill, such as diagnostic tests or treatments, and to check the accuracy of the date to spot potential errors.
Always verify your medical bills carefully and report any suspicious activity to prevent financial and emotional stress. Check out Cryptoscam Defense Network for assistance and most importantly, share your medical scam story with our community to help others avoid becoming victims.
We Want to Hear From You!
Fraud recovery is hard, but you don’t have to do it alone. Our community is here to help you share, learn, and protect yourself from future frauds.
Why Join Us?
- Community support: Share your experiences with people who understand.
- Useful resources: Learn from our tools and guides to prevent fraud.
- Safe space: A welcoming place to share your story and receive support.
Find the help you need. Join our Facebook group or contact us directly.
Be a part of the change. Your story matters.
Frequently Asked Questions (FAQs) About Fake Medical Bill
How Can I Report a Suspected Medical Billing Scam?
To report a suspected medical billing scam, follow these steps:
- Contact the FBI: You can report healthcare fraud to the FBI by visiting your local FBI office or using the online tips form on the FBI’s website.
- Medicare Fraud: If the suspected fraud involves Medicare, you can contact the U.S. Department of Health and Human Services Office of Inspector General or visit their website.
- Provide Details: When reporting, ensure to include as much detail as possible about the suspected fraud, such as the individuals or companies involved, dates, and the nature of the fraudulent activity.
Can I Recover Money Lost to a Medical Billing Scam?
Recovering money lost to a medical billing scam can be challenging, but there are steps you can take to improve your options:
- Report the Fraud: Notify your health insurance company and provide them with detailed information about the fraudulent charges. They may investigate and possibly reverse the charges.
- Contact Healthcare Providers: Reach out to your healthcare providers to clarify any discrepancies in your billing statements. They might correct any errors and refund the money.
- Notify Your Bank or Credit Card Issuer: If you paid the fraudulent bill with a credit card or bank account, inform your bank or credit card issuer. They can help you dispute the charge and possibly recover your funds.
- Assistance Action: In some cases, you may need to seek legal assistance to recover your money. Seek legal advice to explore your options and determine the most appropriate steps to take.
How to Prevent Medical Billing Errors from the Start?
Yes, medical billing errors can be prevented from the start by taking proactive measures:
- Verify Your Information: Always double-check the information you provide to healthcare providers. Make sure your name, address, insurance details, and contact numbers are correct and up-to-date.
- Stay Informed: Educate yourself about common medical billing codes and practices, like overbilling, phantom charges or upcoding. Understanding the basics can help you spot errors in your bills.
- Regular Audits: Regularly review your medical bills and insurance statements. Look for any unfamiliar charges or codes, and don’t be afraid to ask your healthcare provider or insurer for clarification.
What Happens to Medical Billing Scammers?
Scammers of medical billing scams can face serious consequences, including both criminal and civil penalties:
- Criminal Penalties: People found guilty of healthcare fraud can face huge fines and jail time. The length of the prison sentence can vary depending on the severity and scale of the fraud.
- Civil Penalties: Perpetrators may also be subject to civil penalties. This can include hefty fines and being required to pay restitution to the victims.
- Exclusion from Federal Healthcare Programs: Those convicted of healthcare fraud may be banned from participating in federal healthcare programs such as Medicare and Medicaid. This exclusion can significantly impact their professional and business opportunities.
- Professional Consequences: Healthcare providers and professionals involved in billing scams risk losing their licenses and certifications, which can permanently end their careers in the healthcare industry.
Reputational Damage: Being accused of healthcare fraud can lead to reputational damage, affecting the person and any associated healthcare institutions or businesses.
