What Can You Do to Avoid Health Care Fraud?

In June 2025, the U.S. government charged 324 people, including 96 health professionals, with schemes that were meant to lose more than $14.6 billion. This was the biggest fraud takedown in DOJ history.

Health care laws and industry rules change all the time, according to health care fraud lawyer Christopher A. Wellborn. This is why keeping up with the rules that govern billing models and accounting practices in the industry can be quite a challenge. There can be big consequences when you make even small mistakes at a doctor’s office, clinic, or hospital.

Anyone can become a target of health care fraud. Learning about common schemes and protecting your personal data are among the things one can do to help. This will allow you to quickly identify any red flags by verifying who your providers are and reviewing your medical bills on a regular basis.

But what comes next when suspicions arise? Next steps can really make the difference in safeguarding not only oneself but the entire community as well.

Understand Common Health Care Fraud Schemes

Dealing with the intricacies of the health care world requires you to be aware of the common fraud schemes that could affect you firsthand.

One common fraud scheme includes billing you for services never rendered. Phony providers might push irrelevant tests or treatments just to inflate their bills.
Identity theft occurs when an individual utilizes your insurance information to secure medical care without your knowledge.
“phantom billing,” where false claims are filed for nonexistent patients. For this reason, it is extremely important to be fully informed and on guard.

Having knowledge about the common health care fraud schemes can help you shield your loved ones from falling victim to these crimes.

Protect Your Personal Information

Always keep such sensitive information with you and with considerable caution. Before you throw away any paper or material carrying your private information, always shred and destroy it.

Make sure you pay attention and do not give your health insurance number out over the phone unless you are unmistakably certain of the other party’s identity. When in your healthcare account, use a strong and unique password, and also use two-step verification or two-factor authentication whenever available.

Monitor your health statements; any unfamiliar charges would give you cause for concern. If something doesn’t feel right, ask. Staying alert and fighting the battle against health care fraud is not only for yourself but also for helping build a more solid community against it.

Verify Health Care Providers and Services

Before settling with a provider or service for yourself, check their credentials and reputation.

Start with their licenses and certifications, much of which can be checked online or through a local health board. Don’t be afraid to ask for references or check the patient reviews; it will give you an idea of the sort of care you are to expect. Check the experience and specialties, since it could match your needs.

If you can, ask for recommendations from friends and relatives; you want to feel comfortable and confident about your choice. Trust your feeling. If anything about a situation feels awful, it is okay to get a second opinion. At the end of the day, you should have gotten a provider that gives health care while placing your well-being foremost.

Review Medical Bills and Insurance Statements

When you take the time to inspect the documents carefully, not only do you help yourself in the prevention of errors and frauds, but also an honorable cause of transparency and trust in the society is created.

Look for discrepancies, including surprises opposite to the usual charges and services not rendered or a mismatch of the names of providers. Never hesitate to inquire about anything deemed questionable. Your voice matters: stand up for yourself and loved ones. Awareness is the first stage toward building an environment wherein individuals feel safe to choose their way of care.

Report Suspicious Activity and Fraudulent Practices

If you have your doubts and something feels unusual, it probably is. Collect evidence such as billing statements and healthcare providers’ communications, and keep everything clear and documented. Collect evidence such as billing statements or emails between yourself and healthcare providers; make sure to document everything clearly.

Then, you might want to call the insurance company or health department to report something that you feel is suspicious. But remember, you are not alone because there have been many people who went through the same kind of experience; your report will prevent others from becoming victims.

By getting involved, you make a better and safer environment for everyone in healthcare. Together, let us make a network that stands for one another and strengthens integrity in the act of preempting fraud.