How to Detect Health Insurance Claim Fraud

Health insurance claim fraud is the process in which a medical provider bills for services that were never delivered or received. It's a way for medical providers to dishonestly increase their payment. Health care fraud accounts for nearly $70 billion of all health care spending in the United States. It's big business for unscrupulous providers that translates to higher premium payments for consumers.

Things You'll Need

• Documentation of medical services received, including dates, procedures performed and provider name
• Copayment receipts
• Medical bills
• Insurance plan benefit manual
• Insurance company contact information

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Instructions

• 1

  Keep good records of the medical services that you received. Document all procedures and tests performed, dates of visits and tests, and providers who performed them. Retain copayment receipts.

• 2

  Compare your medical service records against your billing statement from your insurance company. Contact your insurance company for a copy of your bill if one wasn't sent to you.

• 3

  Review your insurance plan benefit manual, so you know what's covered by your insurance plan.

• 4

  Note any billing discrepancies you find, such as an added charge for a procedure you don't recall receiving, double billing for the same procedure when it was only completed once, and/or charges for procedures your provider indicated were free.

• 5

  Contact your insurance company right away when you suspect you're a victim of fraud.

• 6

  Report billing discrepancies to your state's Department of Insurance or the attorney general's office. Someone from one or both agencies may ask questions about your claim and request you submit to them copies of your medical records, including receipts and other billing documentation. This will allow them to conduct an investigation.