Most Common Health Care Fraud in the United States

Health care seems to be in the news every day right now. There are some serious changes being made to the health care system in the United States that is causing quite a stir on both the red and blue sides of the country (by which I don’t mean the Crips and Bloods, although that would make for more interesting media coverage).

But as an Englishman, it’s not really my thing. I have more vested interest in the console wars that I will ever have in ACA vs Obamacare. Still, I want to try to stay on subject, and because nothing sparks my interest quite like money, crime and controversy. Here is a list of the more common health care fraud in the United States.


This happens when healthcare providers bill for something that is an updated, costlier version of the thing they actually provided. The name stems from the input of a code which signifies which service was rendered. Because of this, it can be a mistake, but in some cases it’s intentional.

Previous examples of upcoding in the US have included a company that advised their surgeons to bill for expensive and invasive surgeries, even though basic ones were provided.


If many tests and treatments are taken together then the cost will reduce. Unbundling is the act of separating bundled treatments in order to increase the cost. One of the most common examples often given is when multiple tests, such as blood tests, are performed and the hospital bills for each of them as individual tests.

Doctor Shopping

In the US, it is much easier than it should be to get multiple prescriptions from many different doctors. When you’re allowed to advertise prescription medications on TV and when the makers of those products are allowed to push them on doctors, you inevitably create a system whereby doctors are more than willing to prescribe potentially addictive and dangerous drugs.

They will still limit the amount of these that they prescribe, because thankfully they are not idiots. But the patient can simply go to another doctor to get more, and that’s what many do.

Opiates like codeine kill tens of thousands of people a year in the United States. It is an epidemic, and it’s an epidemic because of practices like this.

Stolen ID

The digitalization of healthcare records has led to a number of issues with fraud and ID theft. Records are exposed to hackers and those hackers are assuming identities and then using them to make huge purchases. Hundreds of millions can be lost to this fraud every year and as well as health care industries and insurance companies, patients are also being hit.

Billing for Services not Rendered

One of the most common health care frauds is a health care provider billing for treatments they didn’t give. This happens everywhere, including in the UK, where the NHS foots the bill for genuine and non-genuine care alike. In the US, these schemes are often easier to spot and they can lead to more issues being discovered deeper inside the company.

The investigators will often talk to people who recently left the company, as many health care professionals are honest and will simply leave a company they see to be unethical. They are usually quick to throw their former employers under the bus, and rightly so.