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Examples of Fraud

Fraud can be committed by, and affect, stakeholders across every area of the health care system. Health care fraud is a serious crime that affects everyones health care and is a costly reality that we cannot afford to overlook. Health care fraud is a federal criminal offense punishable by up to 20 years in federal prison.

Most Common Types of Fraud

  • billing for services not provided
  • billing for more expensive services than were actually preformed, commonly known as upcoding
  • performing medically unnecessary services solely for the purpose of reimbursement
  • billing non-covered services (e.g., cosmetic) as other covered services
  • prescription fraud and pharmaceutical diversion to include Medicare Part D
  • providing false information during enrollment
  • accepting bribes or kickbacks for patient referrals
  • routinely waiving co-payments and/or deductibles
  • medical identity theft

Things to Look Out For

  • Review your claims at by selecting View Claims to ensure you have received all services billed under your name.
  • Protect your health insurance card like you would a credit card.
  • Never provide health plan identification number to someone you dont know.
  • Any free medical services being offered at community fairs or other events should never require you to provide your health plan identification number.