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FBIFederal Bureau of Investigation

# Health Care Fraud

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# Health Care Fraud 

Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes.

Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments.

The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs.

The FBI investigates these crimes in partnership with:
                    - Federal, state, and local agencies
                    - Healthcare Fraud Prevention Partnership 
                    - Insurance groups such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units

## Report Health Care Fraud 

We need your help to identify, investigate, and prosecute this crime. If you suspect health care fraud, report it to the FBI at tips.fbi.gov, or contact your health insurance provider.

## Tips for Avoiding Health Care Fraud

                    - Protect your health insurance information.  Treat it like a credit card. Don't give it to others to use, and be mindful when using it at the doctor’s office or pharmacy.
                    - Beware of “free” services.  If you're asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged to your insurance company.
                    - Check your explanation of benefits (EOB) regularly.  Make sure the dates, locations, and services billed match what you actually received. If there’s a concern, contact your health insurance provider.

## Common Types of Health Care Fraud

### Fraud Committed by Medical Providers

                    - Double billing:  Submitting multiple claims for the same service
                    - Phantom billing:  Billing for a service visit or supplies the patient never received
                    - Unbundling:  Submitting multiple bills for the same service
                    - Upcoding:  Billing for a more expensive service than the patient actually received

### Fraud Committed by Patients and Other Individuals

                    - Bogus marketing:  Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
                    - Identity theft/identity swapping:  Using another person’s health insurance or allowing another person to use your insurance
                    - Impersonating a health care professional:  Providing or billing for health services or equipment without a license

### Fraud Involving Prescriptions

                    - Forgery:  Creating or using forged prescriptions
                    - Diversion:  Diverting legal prescriptions for illegal uses, such as selling your prescription medication
                    - Doctor shopping:  Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices

## Prescription Medication Abuse

Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. But the greatest cost is a human one—tens of thousands of lives are lost to addiction each year. Protect yourself and your loved ones by following this guidance:
                    - If you are taking opioids, take them exactly as prescribed by your doctor, ideally, for the shortest amount of time possible.
                    - Never share your medication with others.
                    - Explore non-opioid options with your doctor.
                    - Learn more about the risks of opioid use from the  CDC .
                    - If you have unused or expired pain medications, take them to a  DEA-approved take back site  for disposal.

##### To combat the growing epidemic of prescription drug and heroin abuse, the FBI and DEA released *Chasing the Dragon: The Life of an Opiate Addict*, a documentary aimed at educating students and young adults about the dangers of addiction. Learn more at fbi.gov/chasingthedragon

## COVID-19 Health Care Fraud Schemes

                          -  Woman Pleads Guilty to $359 Million Fraud Involving Claims for Unnecessary Respiratory Tests Submitted with COVID-19 Tests 
                          -  Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat Health Care-Related COVID-19 Fraud 
                          -  Federal Agencies Warn of Emerging Fraud Schemes Related to COVID-19 Vaccines 
                          -  FBI Warns of Potential Fraud in Antibody Testing for COVID-19 
                          -  FBI Warns of Advance Fee and BEC Schemes Related to Procurement of PPE and Other Supplies During COVID-19 Pandemic 
                          -  FBI Warns of Emerging Health Care Fraud Schemes Related to COVID-19 Pandemic 
                          -  FBI Warns Health Care Professionals of Increased Potential for Fraudulent Sales of COVID-19-Related Medical Equipment 

Learn more at fbi.gov/coronavirus

### Related FBI News and Multimedia

                          -  04.10.2024  Rutland Man Sentenced for Conspiring to Access Protected Computer Network of Medical Treatment Facility 
                          -  04.10.2024  United States Files Complaint Against Regeneron Pharmaceuticals Alleging Fraudulent Drug Price Reporting 
                          -  04.09.2024  Holy Health Care Services, LLC Owner Sentenced to Three Years in Federal Prison for Health Care Fraud Scheme 
                          -  04.05.2024  Franklin County Doctor Sentenced to Federal Prison for Health Care Fraud 
                          -  04.04.2024  COVID-19 Testing Fraudster Sentenced to Seven Years in Federal Prison 
                          -  04.04.2024  Arizona Doctor Pleads Guilty to Health Care Fraud 
                          -  04.04.2024  Owner of Telemedicine Companies Pleads Guilty to $110 Million Medicare Fraud Scheme 
                          -  04.03.2024  Three Defendants Sentenced in Fraudulent Nursing Diploma Scheme 
                          -  03.29.2024  Former Health Care Executive Director Indicted for Mail Fraud 
                          -  03.29.2024  Fugitive Cuban National Extradited From Spain and Sentenced to 36 Months’ Imprisonment for Health Care Fraud Conspiracy 

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