How to Report Medical Billing Fraud?

6 min read

Primarily, Healthcare or Medical fraud isn't considered a victimless crime, as it affects people of every age, both individuals and similar businesses. It is also reported that healthcare fraud causes both demographic and financial losses each year. Likewise, it can leverage healthcare insurance premium programs that expose irrelevant medical processes and increase taxes.

If you want to report medical billing fraud, you need to find out the legal ways committed by the medical providers to investigate the patient's details. Whereas the other individuals involved in fraudulent activities may misinterpret the healthcare system to gain illegal benefits or payments at a particular time.

In order to combat all fraudulent activities, you must refer to the guidelines and prospects of the Federal Bureau of Investigation (FBI). Because the FBI is a major law enforcement agency that is helpful in investigating medical billing fraud for both insurance programs, i.e., federal and private. Mainly, the FBI investigates the activities of federal, country-wise, and provincial agencies concerned with medical and healthcare fraud prevention partnership programs. The medical billing companies in Maryland are investigated for crimes in partnership with the following entities:

  • Federal, Country-Wise, and Provincial Agencies.
  • Medical and Healthcare Fraudulent Activities Prevention Partnership Programs.
  • Involvement of Insurance Groups, i.e., National Healthcare Anti-Fraud Association, National Insurance Crime Bureau, and Insurance Investigation Units.

Common Traits to Avoid Multiple Types of Medical Billing Fraud?

You need to identify, analyze, and understand various types of medical billing fraud to avoid complications, redundancy, and illegal workplace activities. To do this, you need to prevent the following types of medical billing fraud:

Protect your Healthcare and Medical Insurance Information

If you have a medical insurance card, you can use it to protect your confidential medical and healthcare details. You can use your medical insurance card as a credit card, but always ensure that you don't give it to anyone or any individual to use it in the hospital, pharmacy, or doctor's clinic.

Get Awareness of "Freemium" Service Models

Acquiring knowledge and awareness of service-based business models is essential to any medical billing company. If you're intimated to provide your healthcare or medical billing insurance information as a 'freemium' service, then the only possible way to protect or secure it is to investigate whether the service is available for free or not or maybe it was charged fraudulently to your medical billing insurance company.

Cross-Check and Verify EOBs Regularly

Another objective of your medical billing insurance verification service is to know about your preferences. You need to check whether the given dates are valid, cross-check the location details, and the medical billing service you recently received. If you have any queries, simply contact your medical insurance service provider.

Tips to Report Medical Billing Fraud

Following are the tips and tricks which will help you to report a medical billing fraud:

Contact the Hospital Billing Unit

If you know that your hospital or medical care unit has made mistakes, then you need to draw the attention of the medical billing staff to avoid such errors and mistakes. You need to look at the hospital or office's website to find the required information to resolve your billing disputes. Let's suppose the billing department does not possess the necessary information, such as the patient's contact details. Then, you need to call the official phone number or ask someone to talk with the authorized personnel.

Request for CFOs' Contact Details

If the hospital and medical billing unit don't correct the billing errors, you need to explain your concerns with the billing aspects to the CFOs and ask them what you can alter them. In some situations, the possibility of contacting the CFO will be sufficient to ensure that the medical billing unit will seriously take your concern.

Similarly, if you have dealt with a small healthcare and medical business unit, office, doctor clinic, or an individual workplace, then you would definitely perceive that there isn't any resource for CFOs in the said organizations. If the case is identical, you can request the department head's contact details, the concerned doctor, or any other high-grade personnel.

Working with a Medical Billing Advocate to Rectify Fraudulent Activities

Working with a medical billing advocate will help you to determine whether any fraudulent activity has happened in the billing process. If yes, you can follow up with the concerned hospital with an annual medical board.

If you're not comfortable making any accusation to the hospital of medical billing fraud, or if you don't have enough time to rectify the concerned issue by yourself, then consulting a medical billing advocate will be the suitable option for you to address the fraudulent activities.

Reporting the Medical Fraudulent Billing

Suppose you have fraudulently reported a medical bill, but the concerned hospital or medical billing service has refused to accept your case. In that case, you may ask the state's health department to intimate your medical bill. Most hospitals have a medical board that evaluates unethical medical activities and fraudulent billings under the national, provincial, or regional health department. This will help you to identify the insurance company for medical billing, which will help you to report the fraudulent billing to the concerned insurance company.

The next phase is to report insurance company fraud to the state's insurance fraud bureau and then make a phone call to report the fraudulent billing activities to a healthcare and medical service provider working under the authority of the affordable care act.


In a nutshell, reporting a medical billing fraud requires a considerable set of activities related to insurance service verification and the legal ways to discover fraudulent medical billing activities. Hence, the above discussion describes the best possible ways to report a medical billing fraud.

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