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How to Protect Yourself From Being Overbilled at the Doctor’s Office



Americans have a long history of trusting the advice, knowledge, and integrity of physicians, with this way of thinking perhaps being most common among older generations. But are some people being taken advantage of?Generally speaking there is nothing wrong with trusting a physician, and it is something that most of us do regularly, but that does not mean there are not plenty of reasons to be a conscientious patient.Today’s health care system is complex, with intricate billing laws and regulations, but having a basic understanding of the physician services you receiveand pay formay go a long way to improving your health and preventing financial loss.

An Example of Fraud

A quick search on the Internet when looking for cases of physician fraud related to billing and services will return plenty of results.Still, some cases receive much more attention than others, and recently an extreme case in Detroit came to light in which a physician consistently made false diagnoses and ordered unnecessary tests, drugs, and even chemotherapy over a two-year period, and billed these services to Medicare. Fortunately, the FBI launched a successful investigation and the perpetrator has been convicted. While cases like this one are the extreme, minor violationssuch as billing for a more elaborate version of a procedureare far more common and may still have negative financial and health consequences for the victims.

How You May Be at Risk

When physicians bill unnecessary services or procedures, it may seem as if only your health insurance company stands to lose, but that is far from the case.Faulty reporting can lead to increased insurance premiums, additional office visits, and more out-of-pocket payments too.Furthermore, on the national scale, this type of abuse can impact us all, working to slowly raise insurance premiums over time. But even more frightening, false diagnoses or procedures may stay on your health record and misinform future physicians (or even the deceitful physician) about your medical history, which could potentially lead to adverse events, improper medication distribution, and further unnecessary procedures, all potentially putting your health at risk and carrying a hefty price tag.

How You Can Protect Yourself

The best way to protect yourself from these types of health care violations is simply to be aware of the services you receive, and check your explanation of benefits and other documentation to be sure that it accurately represents those services.If any invalid procedures are found, your health insurance provider should be notified immediately.It is also a good idea to ask your physician to explain services that they may initiate or recommend, especially if they do not seem to be appropriate for the circumstances.Remember that you have the right to play an active role in your health care, and being informed and aware of the services you are provided, can help protect you from fraud, as well as ensure the best possible level of care. There’s no harm in asking for an explanation or clarification about a procedure, and plenty to gain, even if it only means better understanding the treatment you are receiving.


It’s important not to get carried away and presume that your physician is committing fraud, or to begin to question everything they recommend.However, that being said, it is equally important to recognize that health care fraud is not uncommon in our country, and to understand how to protect yourself from this abuse. Being a conscientious patient may help you to receive the best possible care, while protecting you from the dangers of fraud and its negative financial and health ramifications.

Derek is a technical writer and editor with 10 years of experience in the health care field, having first earned a Bachelor of Arts in English from the University of Delaware. He is a contributing author on a number of textbooks in the medical field, ran a nuclear cardiology licensing course, and has written a variety of other pieces from online training courses to medical software manuals. Derek pursues his personal interest in health and wellness by playing multiple sports and running marathons. An insatiable traveler, he spent 16 months working and living abroad while traveling through South America, Europe, and Southeast Asia.

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