How to report medical billing fraud
August 23, 2022
Last updated on August 23, 2022
5 min read
5/5 (2 votes)

Medical billing fraud is the most devastating threat that the healthcare industry faces, costing billions of dollars. Therefore, it is imperative for service providers to implement adequate protocols with the help of medical billing software

Laws for Medical Billing Frauds

In order to detect and prevent medical billing fraud in your organisation, you must understand key fraud laws for the healthcare industry and implement appropriate compliance measures. According to Federal policymakers, there are three main laws that healthcare service providers must be aware of. 

Federal False Claims Act

This act pertains to civil liability on a person who willingly makes an attempt to submit a fraudulent medical billing claim. If caught, the federal law officials will need specific proof to charge the fraud committing individual.

Anti-Kickback Statute

This law targets individuals trying to receive, offer or pay direct numerations in return for referral services. Therefore, anyone working within the organisation or availing the services of a healthcare provider found guilty of offering or receiving financial favours to work around the system for fraudulent billing claims will be charged with severe penalties. 

Physician’s Self-Referral Law

It is not only the outsiders trying to commit medical billing fraud. Sometimes organisations make referrals to a healthcare service with a family member or acquaintance working or with ownership. This allows the provider to exploit the billing codes. 

Providers, as well as individuals violating the above-mentioned law, are liable to fines and penalties. Moreover, you will most likely not be considered for any federal healthcare opportunities. 

How to Stay Compliant and Prevent Billing Fraud?


The Office of Inspector General (OIG) at the Department of Health and Human Service in the U.S obliges healthcare providers to implement the following to prevent billing fraud. 

  • You must develop and implement a written guideline and policy to promote commitment to billing fraud prevention amongst your employees. You must also have a high-standard medical billing software in place to support your employees’ efforts. 

  • Appointing a chief compliance officer (CCO) and other staff is also mandatory. This department will help record and report any billing frauds to your governing body. 

  • Educate and train your staff regularly to update them on recent billing fraud trends. 

  • You must also maintain a fraud report hotline. 

  • You must implement a process to protect the confidentiality of any whistleblowers by eliminating any instance of retaliation.

  • You must audit and evaluate your compliance adequacy at regular intervals. 

  • In case you detect any billing fraud attempts, investigate them and eradicate the problems in your systems to prevent future incidents. 

Benefits of a Medical Billing Software

Medical Billing Software can help you in more ways than simply preventing fraud. These include

Staying HIPAA-Compliant

Deploying customised medical billing software will allow you to stay compliant with HIPAA standards. Furthermore, it will also help your organisation maintain its compliance status. 

Saving Losses

Adequate billing software such as BillPro can help your organisation save money otherwise lost due to medical billing errors. 

Fraud Prevention by Getting Every Penny You Earned

When you deploy software like BillPro, it helps you simplify your billing process. The software also guarantees that there are no internal fraud attempts involved. With BillPro, there is no need to commit fraud with the right software that helps to get every penny you earned.

Reporting Medical Billing Frauds


If you are a NEMT or a general healthcare service provider and have been a victim of medical billing fraud, here is how you can report the incident:

Gather All Evidence

First, you must gather all the information pertaining to fraud, including fraud committing individual/s details, nature of fraud, relevant documentation, etc. Now it is time to report this to your governing body and relevant authority, the OIG at U.S HHS. 

Contacting OIG by Phone

You can call the Office of Inspector Generation at the U.S Department of Health and Human Services at 1-800-447-8477.

Contacting OIG Online

You can report a medical billing fraud to the inspector general office by visiting their website

Contacting OIG by Fax

You can send a fully documented report by Fax at 1-800-223-8164. However, you must ensure that your report does not exceed more than 10 pages. If your documentation exceeds the page limit, it is best for you to email the report by contacting the office online or send it through mail to the OIG office based in Washington, DC. 


Failing to deploy a healthtech medical billing software can leave your organisation prone to fraudulent attempts from left, right and center. Furthermore, if your employees are unaware of how to detect and identify potential billing scams, this will cause further monetary damages. 

Therefore, you must ensure to not only implement the right billing software but also invest in the training and education of your workers. This combination will help create multiple layers of fraud prevention protocols in place. 

If you are a service provider in the healthcare sector and looking for healthtech software with adequate billing features and security protocols, then BillPro is the answer. Start your 90-day free trial today

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