Wellness Intendance Fraud

Health care fraud is not a victimless crime. Information technology affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each yr. It can raise wellness insurance premiums, expose you to unnecessary medical procedures, and increase taxes.

Health care fraud can exist committed by medical providers, patients, and others who intentionally deceive the health intendance system to receive unlawful benefits or payments.

The FBI is the primary agency for investigating wellness 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 Law-breaking Bureau, and insurance investigative units

Stock image depicting a doctor in a white coat in handcuffs and holding money.

Report Health Intendance Fraud

Nosotros demand your help to identify, investigate, and prosecute this offense. If you lot suspect health intendance fraud, report it to the FBI at tips.fbi.gov, or contact your health insurance provider.

Tips for Fugitive Health Care Fraud

  • Protect your health insurance information. Care for information technology like a credit card. Don't give it to others to use, and be mindful when using it at the dr.'southward role or pharmacy.
  • Beware of "gratuitous" services. If yous're asked to provide your health insurance information for a "free" service, the service is probably non free and could exist 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 business concern, contact your health insurance provider.

Mutual Types of Health Care Fraud

Fraud Committed past 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 really received

Fraud Committed by Patients and Other Individuals

  • Artificial marketing: Convincing people to provide their health insurance identification number and other personal data to bill for non-rendered services, steal their identity, or enroll them in a fake benefit program
  • Identity theft/identity swapping: Using another person's health insurance or allowing another person to use your insurance
  • Impersonating a health care professional person: Providing or billing for wellness 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 go prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices

Prescription Medication Corruption

Creating or using forged prescriptions is a criminal offense, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. Just the greatest price is a human being one—tens of thousands of lives are lost to addiction each year. Protect yourself and your loved ones past post-obit this guidance:

  • If you lot 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.
  • Acquire more about the risks of opioid use from the CDC.
  • If yous take unused or expired pain medications, have them to a DEA-approved have back site for disposal.

To gainsay the growing epidemic of prescription drug and heroin abuse, the FBI and DEA released Chasing the Dragon: The Life of an Opiate Addict, a documentary aimed at educating students and immature adults well-nigh the dangers of addiction. Learn more at fbi.gov/chasingthedragon

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses.

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