How to Spot a Fake Medical Bill and What to Do

Fraudulent medical bills are a growing concern, causing financial and emotional distress. They often charge for unrendered services or inflate costs. Understanding how to identify and respond to such scams is crucial for protecting your finances. This article provides guidance on recognizing suspicious medical bills and the necessary steps to take.

Common Characteristics of Fake Medical Bills

Several features signal a fraudulent medical bill. A common indicator is receiving a bill for services or procedures you never received, or from providers you have no record of visiting. This could involve charges for phantom services or unused equipment. Bills might also appear for duplicate services or items that should have been included in a single charge, known as unbundling.

Legitimate medical bills provide a detailed breakdown of services, including specific dates, descriptions, and medical codes. Fraudulent bills often use vague descriptions like “medical services” or “lab fees” without specific details, making verification difficult. Unusually high charges or for medically unnecessary tests also indicate fraudulent activity.

Pressure tactics and unusual payment demands are another warning sign. Fraudulent bills might demand immediate payment, threaten legal action, or insist on payment through unconventional methods like gift cards, wire transfers, or cryptocurrency. Legitimate providers maintain a professional tone and do not resort to aggressive threats. Discrepancies in contact information, such as phone numbers or addresses not matching official provider details, should raise suspicion.

Errors in personal information, including misspellings, incorrect addresses, or inaccurate dates of service, are common in fraudulent bills. While minor errors occur on legitimate bills, multiple inaccuracies warrant closer inspection. Be wary if a bill requests sensitive personal information, such as your Social Security number or bank account details, which are not typically required for standard bill payment and could indicate identity theft.

Steps to Verify a Medical Bill’s Authenticity

If you suspect a medical bill is fraudulent, verify its authenticity. Compare the bill with your Explanation of Benefits (EOB) statement from your health insurance company. An EOB details how your insurance processed a claim, listing services, charges, coverage, and your responsibility. Discrepancies between the bill and your EOB warrant further investigation.

Next, contact your healthcare provider directly about the bill. Use official contact information from their website or legitimate correspondence, not details on the suspicious bill. Request an itemized bill with a detailed breakdown of services and costs. This confirms the bill’s origin and allows comparison with your records.

Concurrently, contact your health insurance company’s customer service or fraud department, using their official numbers, to verify the bill’s legitimacy and your coverage. Your insurer can confirm if a claim was submitted for the services and if charges align with their records. They can assist in the verification process.

Review your personal medical records and appointment notes to verify the bill’s accuracy. Cross-reference the dates and services on the bill with your records to ensure you received the care. If the bill includes unprovided services or mismatched dates, it indicates a strong possibility of fraud. If uncertain about the provider, check state licensing boards, which offer online tools to verify practitioner licenses.

Reporting Suspected Medical Bill Fraud

If you suspect or confirm a medical bill is fraudulent, report it to the appropriate authorities. A primary avenue for reporting consumer fraud, including medical billing scams, is the Federal Trade Commission (FTC) at ReportFraud.ftc.gov. The FTC uses reports to detect patterns and initiate investigations. While they may not resolve individual cases, your report contributes to broader anti-scam efforts.

Also, report the fraud to your state’s Attorney General’s office. These offices typically have consumer protection divisions or Medicaid Fraud Control Units (MFCUs) that investigate healthcare fraud, especially if it involves government programs like Medicaid. They often provide hotlines or online forms for detailed complaints.

Inform your health insurance company’s fraud department about the suspicious bill. Insurers have specialized units to investigate fraudulent claims because such activities directly impact their operations and members. Providing them with all relevant documentation, including the suspicious bill and your EOB, will aid their investigation.

If the fraudulent bill misused the name of a legitimate healthcare provider, inform the actual provider’s billing department. This alerts them to identity exploitation and helps them take preventative measures. Throughout this process, maintaining detailed records of the suspicious bill, any communication with the provider or insurer, and actions taken is essential for potential investigations or disputes.