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3 Common Types of Health Insurance Fraud

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While most health care professionals are ethical, scrupulous, and “do no harm,” a few abuse their authority and the trust of their patients by committing health insurance fraud. In order to cheat health insurance companies out of more money, some dishonest health care facilities and providers utilize multiple harmful methods that negatively affect patients and insurers alike.

Federal and state agencies are responsible for regulating and disciplining guilty businesses, but patient victims of health insurance fraud should enlist Miami consumer protection attorneys to assist them in filing insurance fraud claims and represent their individual consumer rights. Below are three of the most common health insurance fraud schemes.

Fraudulent Billing

This health insurance fraud occurs when a health care facility or provider includes on a patient’s bill treatments they did not receive. Those committing the fraud get compensated by insurance companies for procedures that were never provided. In the cosmetic surgery industry for example, a common form of fraudulent billing is called Misrepresentation, when a procedure not covered by insurance is misrepresented as a covered procedure. Patients are often unknowing victims of this health insurance fraud.


Health care facilities and providers can overcharge patients and their insurers in multiple ways, and many count as health insurance fraud. Overcharging occurs if a heath care professional charges a high fee for a standard and less costly procedure. Upcoding is another common overcharging scheme in which a health care provider charges for a service with a higher cost than the service that was actually rendered. Unbundling, when providers bill each step and aspect of a medical procedure as a separate procedure, is also often used to drive up patients’ bills.

Falsifying Diagnosis & Unnecessary Treatment

Perhaps the most frightening form of health insurance fraud involves the falsifying of medical records and the ordering of unnecessary procedures for the sole purpose of attaining a higher pay out from insurers. Not only can this result in negative financial consequences for patients, but it could also lead to damaging health repercussion as well. If a health care provider diagnoses a patient with conditions they do not have and then orders tests or procedures that are not medically necessary for that patient or refers them to a second health care provider for specialized treatment in exchange for payment, they are committing health insurance fraud.

If you or a loved one was defrauded by a health care provider, filing an insurance fraud claim can lead you to be properly compensated for the losses you incurred due to the health insurance fraud. At Graham Legal, our experienced Miami consumer protection attorneys are skilled at representing our clients interests and defending their consumer rights. Call today for free consultation.

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