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Healthcare (Health Care) Fraud in the United States

Catalog of Scams – A SCARS Institute Insight

Author:
•  SCARS Institute Encyclopedia of Scams Editorial Team – Society of Citizens Against Relationship Scams Inc.

Article Abstract

Healthcare fraud in the United States is a serious and costly crime that affects individuals, businesses, and government programs alike. It involves deliberate deception by medical providers, patients, or others to obtain unauthorized payments or benefits. Common provider fraud includes double billing, phantom billing for services never rendered, upcoding, and unbundling charges. Patients may commit fraud through identity theft, allowing others to use their insurance, or engaging in bogus marketing schemes.

Table of Contents

Prescription fraud—such as forging prescriptions, doctor shopping, or selling medications—poses especially high human costs, contributing to widespread addiction and thousands of deaths annually. The financial toll is staggering, with tens of billions of dollars lost each year, leading to higher insurance premiums, increased taxes, and unnecessary medical risks. To combat this, the FBI leads healthcare fraud investigations in coordination with various agencies and private partners. Individuals are encouraged to protect their health insurance information, be wary of “free” services, and regularly review their explanation of benefits for accuracy.

Healthcare (Health Care) Fraud in the United States of America - 2025 - on the SCARS Institute RomanceScamsNOW.com - the Encyclopedia of Scams™

FBI PODCAST About Healthcare Fraud

On this episode of Inside the FBI, learn why health care fraud isn’t a victimless crime and how we’re fighting back to keep Americans safe.

Healthcare (Health Care) Fraud in the United States

Healthcare fraud can be committed by medical providers, patients, and others who intentionally deceive the healthcare system to receive illegal benefits or payments.

Healthcare 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.

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

Report Health Care Fraud

Visit ic3.gov, the FBI’s Internet Crime Complaint Center (IC3), to report health care fraud. Also report to the FTC – visit reporting.AgainstScams.org to learn how.

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

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.

Protect Yourself

  • 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.

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If you need to speak with someone now, you can dial 988 or find phone numbers for crisis hotlines all around the world here: www.opencounseling.com/suicide-hotlines

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At the SCARS Institute, we invite you to do your own research on the topics we speak about and publish, Our team investigates the subject being discussed, especially when it comes to understanding the scam victims-survivors experience. You can do Google searches but in many cases, you will have to wade through scientific papers and studies. However, remember that biases and perspectives matter and influence the outcome. Regardless, we encourage you to explore these topics as thoroughly as you can for your own awareness.

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