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7 Potential Signs of Insurance Fraud

7 Potential Signs of Insurance Fraud

Indeed, the only thing certain about life is its uncertainty. It is one unpredictable journey ladened with numerous ups and downs. No matter how much one plans or prepares, the harsh reality is that the future can never be controlled. This is especially true when it comes to our health. Even the healthiest among us are not immune to getting sick or injured.

This is where insurance comes in. Insurance provides peace of mind by protecting us financially in case of an unexpected health emergency. It is a safety net that allows us to focus on getting better without worrying about how we will afford our medical bills. However, Bill Schantz of Mid Atlantic Financial LLC emphasizes that there are always people who try to take advantage of the system. Insurance fraud is a serious problem that costs billions of dollars every year.

Signs of Insurance Fraud

Billing for services not rendered

According to Bill Schantz, this is the most common type of insurance fraud. It occurs when a provider bills an insurance company for services that were never actually provided. This can be done by billing for a more expensive service than was actually performed or for services that were never performed.


Upcoding is similar to billing for services not rendered, but it refers specifically to billing for a more expensive service than was performed. For example, a doctor may bill for a brand-name medication when a generic was prescribed or bill for a more complicated procedure than was actually performed.

Unnecessary tests and procedures

This type of fraud occurs when providers order unnecessary tests or procedures in order to collect insurance reimbursements. These tests and procedures may not be medically necessary and may even harm the patient.

False diagnoses

Sometimes, providers may give patients a false diagnosis to justify billing for unnecessary tests and procedures. This type of fraud is especially dangerous because it can lead to patients receiving unnecessary treatment for conditions they don’t actually have.


Kickbacks are payments made to providers in exchange for referring patients to a particular facility or provider. These referral fees may be illegal and can increase the cost of care for everyone involved.

Phantom patients

Insurance fraudsters may create false patient records to bill for services that were never provided. This can be done by using the identities of real people or by making up entirely fictional patients.

Billing for personal expenses

Sometimes, providers may bill insurance companies for personal expenses, such as vacations or luxury items. This is obviously a form of fraud, and it can be challenging to detect. It can indicate someone is trying to defraud their insurance company by claiming that these expenses were incurred for business purposes. If you see a pattern of this type of activity, it may be worth investigating further.

Bottom Line

Bill Schantz emphasizes that if you suspect that someone may be committing insurance fraud, it’s essential to report it. Insurance fraud drives up the cost of care for everyone involved and can lead to patients receiving unnecessary or even harmful treatment.