Medical Billing

# How to Spot a Fake Medical Bill: Signs & Prevention Tips

- April 14, 2025
- Posted by Brian Bertrand

09 Apr

The medical industry has been affected by scams and fake medical bills for ages and till now there have been no easy solutions for the prevention of manipulation and tempering of such issues at the receiver’s end (i.e. hospitals and providers) or the processors’ end (i.e. insurance companies). The Healthcare industry needs a quick solution that would ensure the processing of fake medical bills and authenticate that the fake claims are rejected.

Currently, the health sector manages the process manually which is time taking, expensive, error-prone, and tedious. The United States medical industry has lost hundreds of millions of dollars each year due to fake billing and scams. This happens because of a plethora of regulations being written over more than 45000 pages which provide unlimited opportunities for loopholes that bring in chances for scams. Here are five types of scams and frauds in the medical billing that are spotted mostly and details on how to avoid them.

## Common types of Fake Medical Bills

### Upcoding

source:netsuite.com

Suppose a patient visited the hospital for a sprained ankle and received treatment for it but the hospital billed the insurance provider for the treatment of a broken ankle. Has this been manipulated or happened by a mistake?

This scam would be called ‘upcoding’. Because the provider has to attach the CPT code list with every claim to show each procedure and treatment performed. These codes depict how long or short the subsequent bill should be for the rendered treatment.

Many insurance companies deal with a range of hospital and provider bills on a regular basis, they are computer organized, and this is why many common mistakes of coding are often overlooked.

Dallas University of Texas Southwestern Medical Center paid around $1.4 million to settle the claim against the allegations of fraud in Medicare and Medicaid bills. This lawsuit in 2007 acted like a whistleblower and brought the fraudulent practices to light. However, the medical center did not accept the allegation but had to settle the case and pay the amount to waive off the allegation which is possibly a mistake.

### Phantom Billing

> CEO of CRTMedical.com stated that:

> “One of the most common types of billing fraud has to do with services being billed that were not actually performed. This type of fraud impacts the cost of health care because it drives up the cost by the mere fact that the charges are not justified but there are also millions of dollars spent each year tracking and finding this fraud and stopping it from happening. The Government in the past 3 years has put in place RACs (Revenue Audit Contractors) who are paid a % of any fraudulent or incorrect billing practices.”

A practice that had to pay the federal government $2.5 million over claiming hundreds and thousands of bills for the treatment that had never happened. Maryland orthopedic also doubled the payments for services like X-rays and scans to get a higher number of reimbursements.

These kinds of claims not only affect the cash flow and policies of the federal government but also affect the overall liability of a patient in health insurance. The financial claims show the services that a patient had received and thus influence future treatment. So, try to keep yourself from Phantom Billing.

### Inflated Hospital bills

Inflated bills are a form of overcharging for the treatment to insurers. Linda Burdick, Chief Assistant State Attorney, said that she felt that she had received an inflated bill of $60,000 recently after back surgery to her insurance. She hired financial issues investigators and found that the bill was inflated for things like 6 surgical screws worth $1,750 each.

> According to Liz Osborn, a healthcare bill navigator,

> “I’ve never seen a hospital bill that I thought followed all the regulations correctly. Not once.” The hospital couldn’t defend itself, however, meekly claimed that there was “no evidence of overcharges in her bill” but are “willing to correct any mistakes.”

For everyone who receives medical treatment must review the bills and mistakes for over and double charging mistakes from hospitals.

### Service Unbundling

This scam happens when hospitals charge multiple procedures separately when they are supposed to be in a package deal and submitted altogether. This separate procedure of billing makes an apparent high charging invoice.

Unbundling is also referred to as ‘fragmentation’ and is a form of up coding. These higher billing scams usually affect patients with insurance from Medicaid and Medicare. This is because they are the systems that offer special packages mainly on the procedures that patients often are prescribed such as lab tests and scans.

Providers and healthcare practitioners bill these packages separately removing the package rates to fraudulently increase the profit.

Recently, Genesee Valley Cardiothoracic Group settled for a $2 million alleged lawsuit for submitting claims for ‘assistant attending claims’. The settled amount of $ 2 million went to the federal government after the claim received a false verdict. This is because according to the rules of Medicare when the qualified cardiothoracic surgeon is present at the time of surgery, assistant attendees or assistant surgeons are not required and cannot be billed.

### Self-Referrals

The first thing that you must know about self-referrals is that it is illegal. Self-referrals mean that you refer yourself for a surgery or procedure that your patient needs in order to get compensation. The law makes it illegal for the providers to self-refer to prevent unnecessary procedures which promote excessive use of resources and eventually they make more profit.

## How to Spot A Fake Medical Bill

People deal with medical bills regularly but they must also contend with fake medical bill scams. Fake doctor bills along with fake hospital bills have become frequent concerns which most people fail to detect. Protecting yourself from medical bill scams requires mastering the ability to detect fake doctor bill. This article will explain the process of recognizing fake hospital bill . The article will educate readers about medical bill authenticity detection through explanations of detecting fake charges issued by the Pediatrix Medical Group fake bill as one key example of medical bill scams.

## How to Spot a Fake Medical Bill After Your Recovery

The medical billing system functions as a complicated mechanism that generates confusion when patients try to separate real charges from fraudulent claims. Patients must learn to detect fake doctor bills and fake hospital bills because medical bill scams are becoming more prevalent. This article will cover everything you need to know about identifying fake medical bills and understanding how to recognize fraudulent medical charges through examples like the Pediatrix Medical Group case.

- Detailed Review: Every medical bill you get must receive your full and careful inspection. Carefully examine your medical bill to make sure all the services and added charges match what you received.
- Comparison with Insurance Statements: You must cross-check medical invoices with corresponding Explanation of Benefits (EOB) details issued by the insurance provider. Verify that the medical bill amounts and provided services are identical.
- Verification with Healthcare Providers: Contact your healthcare providers directly for confirmation regarding your medical bill details. Request additional verification of services together with their pricing from the healthcare providers.
- Review every specific detail in the bill: A fraudulent medical invoice contains minor mistakes which do not match those found in authentic medical institutions. An illegitimate medical bill might contain wrongly filled information such as names and addresses and incorrect dates. The medical bill should be cross-checked against your medical records to ensure all stated information is accurate.
- Manual Review: A detailed examination must be performed between each medical bill and the related patient medical records. Examine the patient information including names and identification numbers along with treatment description details in the invoice.
- Use Technology: Medical facilities should implement AI authentication solutions to verify administrative documentation with prompt and error-free precision. Utilizing these systems enables quick recognition of irregularities which includes instances of duplicate payments and wrong patient record entries.
- Verify the Medical Provider: Ensure to confirm the legitimacy of bills that come from unfamiliar medical providers before you pay anything. Scammers fake their organization names to match famous healthcare providers with the goal of deception..
- Review the Charges Carefully: Scam operators embed fake medical services and artificial price enhancements into their medical billing practices. A medical bill fraud may contain false charges that identify services that were never performed. You should check if the bill contains unfamiliar service descriptions because this indicates possible billing fraud. You should check for inaccuracies by comparing the bill’s amounts with what your insurance provider shows in their records.
- Check for Missing: Medical expenses which are legitimate will always originate in confirmed medical facilities while providing complete contact information. General and undetailed contact information on a bill might indicate potential fraud. Medical scams typically avoid displaying medical facilities or doctor offices in their payments within the billing documents.
- Beware of Urgent or Threatening Language: Scammers will frequently use urgent language in fraudulent medical bills to create panic and force recipients to rush their payments. Scammers will warn that you will be sent to collections or face legal action unless you pay immediately. A legitimate provider will always maintain a respectful tone and avoid aggressive or threatening language.
- Look for a Lack of Insurance Information: Legitimate medical bills will provide information about your insurance coverage and payments made. Fake hospital bills could lack these details or contain incorrect information. You should look into a bill more closely if it fails to display insurance payment information or coverage amounts.
- Check the Bill’s Format and Design: Medical providers generally send bills that follow standardized layouts and feature clear formatting. Fake medical bills might display strange fonts together with strange formatting or demonstrate poor printing quality. A medical bill that appears unprofessional or does not match your past billing documents might be fraudulent.
- Verify Through Your Health Insurance Company: You should reach out to your health insurance provider to verify any charges if you have insurance coverage. Health insurance firms typically issue statements detailing the medical services they have funded. Your medical bill does not align with your insurance statement which suggests a medical billing scam. Review the bill carefully if its total amount greatly exceeds the amount your insurance company has listed.
- Educate Yourself on Common Scams: Understand how medical billing fraud operates through tactics such as excessive billing and upcoding where providers charge for higher-priced services than those rendered.
- Consult Resources: Seek guidance from consumer protection websites or local health departments to help you recognize fraudulent bills and learn how to report them.

## How To Tell If A Medical Bill Is Fake

While spotting a fake medical bill demands attention to detail, several important signs can assist you in determining its legitimacy.

- Look for Red Flags in Billing Codes: Medical billing relies on particular codes to document various medical procedures and services. Invalid codes or codes without medical meaning that do not relate to genuine medical services are typical characteristics of medical billing fraud. When you encounter unfamiliar codes or services on your medical bill ask your healthcare provider to explain what those charges represent.
- Review the Details: Review the patient information alongside service dates and treatment descriptions for any inconsistencies. Every authentic medical bill displays information that remains accurate and consistent throughout.
- Compare the Bill with Previous Statements: When you receive a bill from a healthcare provider you have previously used compare it against any previous medical bills you have received. Medical providers that operate legitimately often maintain regular billing methods. A bill that differs in format and detail from previous statements may indicate it is a fraudulent medical bill.
- Look for Discrepancies in Service Dates: Fraudulent bills can appear for services that were not actually performed or include services with incorrect dates. A discrepancy between the bill dates and your medical records or personal recollection might indicate fraudulent billing. Confirm with your healthcare provider or insurance company that the service dates listed on your bill are correct.
- Confirm Payment Records: A detailed record of payments made by either yourself or your insurance provider will appear in most medical bills. A hospital bill that lacks payment documentation or displays fabricated payment records might be fraudulent. Verify your bank statements and insurance provider records to confirm that payments have been properly documented.
- Look for Suspicious Payer Information: Fake hospital bills sometimes include incorrect details about the payer such as your insurance company name or fictitious entities. Verify that the payer information on the bill matches your insurance provider or payment plan details.
- Check the Source: Verify that the healthcare bill originates from a legitimate provider or facility. An invoice originating from an unrecognized source or lacking professional branding could indicate fraudulent activity.
- Examine Billing Codes: Familiarize yourself with common medical billing codes. Unfamiliar billing codes or excessive charges suggest possible fraudulent activity.
- Verify with Your Provider: Use contact details from the healthcare provider’s official website to verify bills instead of information printed on the bill. Ensure that all services billed to you actually took place.
- Look for Unusual Charges: Avoid charges for services you didn’t receive and services that exceed local standard rates.
- Check for Duplicate Bills: Scammers can send several bills for identical services to deceive patients. Review the latest bills against older ones to check for repeated charges.

## Pediatrix Medical Group Fake Bill

Consumers frequently report fraudulent charges from businesses such as Pediatrix Medical Group which specializes in neonatal and pediatric health services. Recent reports show Pediatrix Medical Group issued fake bills causing patients to face unexpected payments for services that were either not provided or wrongly billed.

Upon receiving a medical bill that falsely represents Pediatrix Medical Group as the issuer you need to follow specific steps.

- Verify the Charge with Pediatrix: To contact the company about the bill use their official website contact information instead of the number listed on the bill. Inquire about the details of the bill and confirm whether any services were delivered to you or your child.
- Check Your Insurance Records: Compare the charges on the bill with your insurance provider’s records to determine if they align with any Pediatrix Medical Group claims.
- Look for Scams Online: People who receive fake bills from Pediatrix Medical Group commonly share their experiences through online forums and social media platforms. Review online platforms to determine if other individuals have received bills similar to yours.
- Consult Your Doctor: When a charge from Pediatrix raises questions, contact the doctor or medical provider who referred you to them. Your doctor or medical provider who referred you to Pediatrix can help determine if the charges are legitimate.

## Reporting Unethical Behavior or Scams in Healthcare

Fortunately, the medical industry is widely self-regulating. Many times it becomes an obligation for a physician to report if they see a provider/physician/hospital engaged in scams and frauds. In addition, if they see that patients are in immediate threat, they can report that incident to the state licensing board or medical community for instant action.)

Even if you are at a receiving end (patient) having a firm belief that your healthcare provider is involved in unethical or illegal behaviors, you must lodge a complaint that can either improve the quality of healthcare or clear the clutter that made you believe the process in the first place. Find your state health department and reach out for help in cases of reporting scams and fraud when you witness it.

## Conclusion

In today’s era it is vital to recognize fake medical bills because medical billing scams now use more complex methods. The best self-protection method against fake doctor bills and fake hospital bills involves careful examination of details and verification of charges. Checking for information mistakes and matching charges to insurance documents while avoiding aggressive behavior helps you prevent scam victimization. If you receive a fraudulent invoice from Pediatrix Medical Group you should validate the expenses to protect yourself from potential scam activity. Trust your instincts as they guide you to investigate when something looks unusual.

But you can trust us and hire our Medical Billers to streamline and maximize your revenue. And also Check out our Billing Services for Cardiology Specialists.

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