Responding to Fraudulent Healthcare Treatment Billing Practices

Dealing With Fake Medical Bills: What To Do When You’re Charged For Treatment You Didn’t Get

Getting a medical bill can already be stressful enough. But opening up your mailbox and finding a charge for treatment you never even got? That’s a whole other level of panic.

Unfortunately, bogus billing happens more often than you’d think. Whether it’s an honest mistake or outright fraud, you could end up paying for care you didn’t receive. So what do you do if you find a suspicious charge on your statement?

Don’t ignore it and hope it goes away. You need to take action to get to the bottom of the issue. Here’s how to respond when you think a medical bill is fraudulent:

Review The Bill Carefully

First things first – scrutinize the actual bill. Make sure the dates of service match up with when you saw a doctor. Confirm the provider name is someone you’ve actually seen before. And verify the treatment codes describe care you really got.

Small errors like a wrong date are usually just innocent mistakes. But charges for a doctor you’ve never visited at a facility you’ve never been to? Red flag for sure.

While you’re looking it over, check for other fishy signs like:

  • Treatment that doesn’t relate to any health issues you have
  • Services that seem excessive or unnecessary
  • Bills sent long after when you were treated
  • Multiple bills for the same procedure

The more discrepancies you can point out, the better.

Contact The Provider ASAP

If anything looks off, get in touch with the doctor’s office or medical facility right away. Explain the situation and ask them to investigate the charges. There might be a simple explanation like a clerical error.

But if the billing department can’t justify the costs, make it clear you dispute the charges. Ask them to send documentation like medical records proving you received the treatment. Don’t pay anything until you sort it out!

Getting the provider involved early can help nip bogus bills in the bud. Their records can show if you really were a patient on those dates. Most legitimate organizations will work with you to fix incorrect charges.

Check Your Insurer’s Records

Your insurance company can also help verify suspicious billing. Contact them to check if the charges were actually submitted by an in-network provider.

Ask if they paid out anything to this doctor or facility for your care. If not, it’s definitely a red flag. Share any records you have and explain why you don’t think you owe the amount billed.

The insurer can advocate on your behalf and deal with the provider directly. They can even help identify patterns of fraud if this has happened to other members.

Watch For Costly Coding Errors

One common billing problem – upcoding. This is when a provider uses billing codes that represent more expensive services than what you actually received.

For instance, your doctor bills for a 30-minute consultation when you really just had a short 5-minute chat. Or they charge you for a comprehensive lab panel when only a basic metabolic test was run.

Upcoding is done to inflate costs and increase insurance reimbursement. But it leaves you stuck with a higher bill.

Carefully examine the treatment codes and confirm they accurately reflect the care you got. Ask the provider to change improper coding that doesn’t match your visit.

File Appeals If Needed

If talking to the provider and your insurer doesn’t resolve the issue, you may need to file appeals. This formally disputes the charges and prompts an investigation.

First appeal to the provider’s billing department in writing. Include copies of any records that show the treatment wasn’t performed. Make sure to follow their appeal process and meet all deadlines.

If they deny your claim, you can then appeal to your insurance company. Ask them to reprocess the claim since you dispute the charges. This may require filling out forms and providing documentation.

Don’t let bogus bills get paid just because you didn’t speak up! Going through the appeals process forces the provider to justify the costs.

Watch For Medical Identity Theft

In some cases, fraudulent billing is a sign your medical identity was stolen. This is when someone else uses your personal information to obtain healthcare services under your name.

Warning signs include:

  • Bills for treatment in a state you don’t live in
  • Collection notices for care you never got
  • Denied insurance claims for services already paid

If you suspect identity theft, get copies of your medical records from providers. Check for any services you don’t recognize. Also request a copy of your claims history from your health insurer.

Report potential fraud to the police and your insurer’s fraud department. You may need to file identity theft reports to clear your name from false charges. Monitor your account statements closely for any other suspicious activity.

Don’t Delay – Dispute The Charges!

Dealing with medical billing errors or fraud takes diligence. But you have every right to fight back against illegitimate charges.

Don’t let fear of hassle stop you from speaking up. And don’t stress about being seen as confrontational – you’re just protecting yourself.

Comb through each bill carefully and contact providers right away if anything seems off. Keep records of all conversations and appeals. With persistence and patience, you can get the matter resolved!

The billing process has plenty of room for mistakes. But you shouldn’t have to foot the bill for treatment you never received. Stay vigilant against improper charges – and know your rights when disputing fraudulent bills.