This site uses cookies.

Know the major medical fraud types to avoid getting duped

Consideration was given for the editing and publication of this post.

Medical abuse, waste, and fraud are some of the common problems ailing the global medical system. You will be amazed to know that the medical fraud market is booming with an annual waste of $450 billion all over the world. Even with the FWA fighting to curb medical fraud through billing and identity theft, the efforts have so far been futile. Even the WHO or the World Health Organization has deemed the FWA efforts as inefficient.

About the FWA and who is affected?

If you are paying for healthcare in the USA, then you are affected the worst through medical frauds. The FWA either charges high with the premium amounts or the tax, which in turn is responsible for the lower rates provided to us, the people. Every time the private payer is forced to negotiate with the service providers, the network shrinks and the business runs into massive losses. In easy terms, the smaller the budget for the providers, the lower is the quality of the healthcare with high charges and premiums.

Why should you know about healthcare fraud?

Since you are the payer for the medical services, you are fighting the battle at the frontline. You are the one to bear the full force and the brunt of the illegal practices. If you are able to identify fraud, you can prevent further cases as well as stake your claim to save huge. The only way to avoid is to understand the scams better.

So, let us have a look at some of the common types of medical fraud, according to the experts at the Healthcare Fraud Group.

Unfair billing

Many healthcare providers will bill you for procedures, surgeries, and treatment that were never performed on the patient. This is done by using a patient's healthcare information or by unscrupulous means including identity theft. These embellished claims affect millions worldwide.


A falsification of the bill, where a service is made to cost more than the original quotation is called upcoding. This practice is routinely performed by healthcare providers, and it involves falsifying medical records so that it becomes difficult for a person to apply for medical insurance. Always watch out for non-existent medical conditions.

Unnecessary services

This is a type of medical fraud and abuse where a specialist asks you to go for a test or multiple tests with prior knowledge that it is entirely unnecessary in your case. Its sole purpose is to bill the insurance provider.

About misrepresentation

This is quite a diabolical fraud and usually seen in cases of plastic surgery. Here the name of a procedure not covered by the insurance is changed to one that has insurance coverage.


Often a medical service will charge you more for separate procedures by unbundling them. This is a type of healthcare abuse and fraud that is highly prevalent these days.

About kickbacks

Kickbacks from pharma manufacturers are quite common. These days kickbacks are issued and accepted for patient referrals as well through unnecessary treatments. Make sure that your insurance payments are not collected through unscrupulous means by being aware.

If you are suspecting foul play and think you are a victim of healthcare fraud and abuse, always consult expert legal help.

All information on this site was believed to be correct by the relevant authors at the time of writing. All content is for information purposes only and is not intended as legal advice. No liability is accepted by either the publisher or the author(s) for any errors or omissions (whether negligent or not) that it may contain. 

The opinions expressed in the articles are the authors' own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand. 

Professional advice should always be obtained before applying any information to particular circumstances.

Excerpts from judgments and statutes are Crown copyright. Any Crown Copyright material is reproduced with the permission of the Controller of OPSI and the Queen’s Printer for Scotland under the Open Government Licence.