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What should I do if I suspect my doctor of fraud?


What To Do If You Suspect Your Doctor of Fraud

If you have a feeling your doctor is doing something illegal or unethical, it can be scary. You put your trust in this person to care for your health, so finding out they may be dishonest can feel like a betrayal.

But you don’t have to keep quiet if you suspect your doctor of fraud. There are steps you can take to report them and make sure they are held accountable.

Trust Your Instincts

First, don’t ignore your gut feeling. If something seems off with the way your doctor bills your insurance, prescribes medications, or recommends unnecessary procedures, pay attention. Some signs your doctor may be committing fraud include:

  • Billing for services they didn’t perform
  • Billing multiple insurers for the same procedures
  • Prescribing brand-name drugs when generics are available
  • Ordering excessive or unneeded tests

Of course there could be valid reasons for some of these behaviors. But if you have a nagging feeling something shady is going on, it’s smart to investigate further.

Do Your Research

Before making any fraud accusations, make sure you have evidence to back up your claims. Do some digging like:

  • Review your medical bills and EOBs from your insurance to verify services billed
  • Research average costs for procedures you had to see if you were overcharged
  • Look into your doctor’s credentials and disciplinary history
  • See if others have filed complaints about similar misconduct

If you confirm questionable billing practices or excessive procedures that aren’t medically warranted, you’ll have documentation to demonstrate why you suspect fraud.

Christine Twomey
Christine Twomey
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
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Keisha Parris
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
Very professional, very transparent, over all a great experience
Bee L
Bee L
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divesh patel
divesh patel
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

Report Your Doctor

Once you’ve gathered information about potential wrongdoing, it’s time to file a report. You can notify these agencies about your doctor:

When filing your complaint, present the details about your suspicions clearly along with any proof. Records like visit summaries, test results, billing statements, and payment receipts can help support your allegations.

What Happens Next

After reporting doctor fraud, investigators from agencies like the FBI, IRS, or HHS Office of Inspector General may get involved. They’ll examine factors like:

  • Medical necessity of services
  • Billing irregularities and overpayments
  • Suspicious prescribing patterns
  • Procedures billed that weren’t performed

Your doctor will have a chance to respond to the fraud claim. If enough evidence demonstrates wrongdoing, they may face:

  • Fines and repayment demands
  • Loss of medical license
  • Exclusion from state/federal healthcare programs
  • Criminal charges like wire fraud, identity theft, or kickback violations

As the person who reported your doctor, you likely won’t be updated about details of the investigation. But you can rest assured the proper authorities will discipline your doctor appropriately if they discover unlawful activity.

Consider Finding a New Doctor

Even if agencies are still investigating your doctor, you may want to look for a new provider. Continuing care from someone you suspect of fraud can feel really uncomfortable. It may damage the honesty and trust that are essential in a good doctor-patient relationship.

Shop around for an ethical doctor you feel you can count on to offer first-rate care without overbilling insurance or recommending needless procedures. Having confidence in your provider’s integrity will lead to better health outcomes.

Suspecting your own doctor of fraud is an awful position to be in. But coming forward about your concerns can stop ongoing misconduct that wastes healthcare dollars and risks patient wellbeing. Pay attention to warning signs, thoroughly document issues, and report shady behavior to protect yourself and prevent future victims.


U.S. Department of Health and Human Services Office for Civil Rights: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Medicare: https://www.medicare.gov/MedicareComplaintForm/home.aspx

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