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Four common types of healthcare billing fraud

On Behalf of | Jan 10, 2023 | Whistleblowing |

Medicare patients rely on their healthcare providers to provide them with the treatment they need and to charge the government fairly for that treatment. Unfortunately, some clinics and hospitals misrepresent their services to charge more for care and bring in more profit from services to government beneficiaries.

What should you know about these common types of fraud committed by healthcare providers against government payors?

Phantom Billing

Phantom billing occurs when a healthcare provider charges for services, equipment, or medication even though a patient did not receive that care. For example, in a 2021 case where Cross Law Firm represented the whistleblower, a clinic allegedly billed for one-on-one physical therapy that patients did not receive.

Double Billing

Double billing occurs when a healthcare provider bills more than once for a service or treatment. This may occur if a healthcare provider submits two claims for a procedure when the provider, in fact, performed the procedure only one time.


Unbundling occurs when a healthcare provider splits a service into multiple billing codes in order to receive a higher amount. For example, billing for a routine surgery may include aspects of the surgery like an incision or stitches. Unbundling could occur if the healthcare provider billed individually for those parts of the procedure.


Upcoding occurs when a healthcare provider intentionally misrepresents the treatment that a patient received, charging them for a more expensive treatment. One example of upcoding might be billing for a brand-name medication when the patient received a generic drug. Upcoding could also occur when patients receive care from a nurse or physician’s assistant, but the bill indicates that a physician instead provided these services.

Fraud in the healthcare system is a serious matter and can significantly impact patients and the government programs that often support them. If you have evidence of fraud in a healthcare facility, you may want to consider your options for reporting that misconduct.

Cross Law Firm has recovered millions for their whistleblower clients.