What is health care fraud?

Health care fraud is a serious business in the U.S. — and a serious crime.

There are many different kinds of health care fraud. Common examples include:

  • Using an expired or fraudulent identification card to get medical services or medications 
  • Lending an ID card to someone who isn't entitled to it 
  • Adding someone who isn't eligible for coverage to a contract 
  • Providers who bill for services never rendered 
  • Performing medically unnecessary services to receive payment from insurers
  • Billing for more expensive services or procedures than were actually provided 
  • Accepting kickbacks for patient referrals 

How fraud impacts you

For consumers, health care fraud equals higher premiums and out-of-pocket costs, and reduced benefits and coverage. Fraud also hurts employers by driving up the costs of providing benefits to employees and doing business.

Estimates put the amount lost to health care fraud at between 3 and 10 percent of overall health care spending — between $68 billion and $226 billion. With health care costs on the rise, the price tag for fraud is likely to climb unless efforts to combat it are successful.

Fraud carries other implications for victims. You could:

  • Be subjected to unnecessary or unsafe medical procedures or treatments
  • Find that your insurance benefits have unexpectedly been exhausted
  • Have erroneous information added to your medical records
  • Receive the wrong medical treatment
  • Unexpectedly fail a physical examination for employment
  • Be deemed uninsurable as a result of medical identity theft