Common medical scams that should be on every doctor’s radar

By Naveed Saleh, MD, MS
Published August 26, 2021

Key Takeaways

Healthcare fraud is big business. In research cited by Blue Cross Blue Shield, conservative estimates peg the cost of US healthcare fraud at $68 billion annually. This number could be as high as $230 billion, or a whopping 10% of the country’s healthcare costs.

As a physician, it is very unlikely that you will ever fall for (or promote) fraudulent healthcare claims or practices. Nevertheless, your patients could be duped. With that in mind, let’s take a look at four common forms of healthcare fraud.

False weight-loss ads

According to the CDC, in 2017-2018, 42.5% of the American population aged 20 years or older was obese and 73.6% was obese and overweight.

Many Americans want to shed pounds and often look for an easy fix. But the FTC warns of fraudulent weight-loss products. In addition to being ineffective, these products, such as pills, powders, patches, or creams, can be dangerous.

The Commission provides tips on spotting fraudulent products in advertising. The ads often promise the following::

  • Weight loss without diet/exercise

  • Permanent weight loss

  • Not having to monitor intake

  • “30 pounds in 30 days”

  • A cream or patch that causes weight loss

  • A product that “works for everyone”

  • Magical pills that result in weight loss

You can advise patients that:

  • The only diets that work involve sensible caloric intake and exercise.

  • FDA-approved fat-absorption blockers or appetite suppressants work only with a low-fat/low-calorie diet and exercise plan.

  • No “one-size-fits-all” product or service exists for weight loss.

  • Lasting weight loss requires permanent changes in diet and exercise patterns.

  • No weight-loss product is effective on a (dangerous) lightning-fast timeline.

  • No weight-loss product allows the user to eat all they want.

  • Patches don’t work for weight loss.

False infertility supplements

According to the Office on Women’s Health, nearly 10% of American women between 15 and 44 years of age struggle with getting or staying pregnant. These women may purchase false fertility treatments.

In May 2021, the FDA issued warnings to five companies for illegally selling supplements that claim to cure, treat, mitigate, or prevent infertility and other reproductive diseases.

"Dietary supplements that claim to cure, treat or prevent infertility and other reproductive health conditions can potentially harm consumers who use these products instead of seeking effective treatments, such as FDA-approved drugs or assisted reproductive technology,” said Judy McMeekin, PharmD, of the FDA. “Protecting the health and safety of Americans is the FDA’s highest priority, and we will remain vigilant in warnings about products and companies that place consumers at risk.”

Other bogus healthcare products

Scam healthcare products are not only limited to weight loss and can include a host of other purported drugs and supplements, including those that fight cancer, dementia, or infections.

According to the FDA, “Scammers promote their products with savvy marketing, often using tactics that target specific populations via the web and email, but also by word-of-mouth, newspapers, magazines, TV, and direct mail. Health fraud scams run rampant on social media sites and closed messaging apps, such as Signal, Viber, WhatsApp, and Facebook Messenger.”

They added, “Health fraud scams can also be found in other locations such as convenience stores, gas stations, flea markets, and nontraditional stores, targeting those with limited English proficiency and limited access to healthcare services and information. Other risks include potentially dangerous or unproven products ordered directly from overseas sources via mail to circumvent normal Customs and FDA inspections and other safety measures.”

According to the FDA, patients can identify bogus products by the following:

  • Personal “success” stories, such as the product “cured” diabetes or stopped COVID-19

  • Quick fixes, such as “cured cancer in 30 days”

  • One product that cures many or every disease

  • “Miracle” cures

  • “All-natural” cures or treatments

  • Products that play into conspiracy theories (eg, Big Pharma, COVID-19 mis- or disinformation)

If your patients encounter such scam products, you can advise them to report the products to the FDA. They can also call 1-800-FDA-1088.

For more on medical conspiracy theories, click here.

Billing for unrendered services

The vast majority of physicians and other healthcare providers are upstanding, compassionate, and ethical individuals intent on doing their best for patients. But, as with any field, there are bad apples.

In a cover article published by the Association of Medical Fraud Examiners, a healthcare investigator wrote, “In almost every healthcare fraud examination I've conducted, I've found evidence that the medical provider or its facility submitted claim forms to government healthcare plans and/or insurance companies for services and care—that were never provided—and the corresponding patient files had no supporting documentation. It makes sense that if a fraudster would commit any of the other schemes listed above, which takes a bit of brainpower and effort, they might as well throw in some extra dates and codes on the claim forms to try to make some real easy money.”

Keep in mind that an investigator can go to certain lengths to uncover such scams. They check appointment times, sign-in sheets, and provider records, as well as interview patients and staff. Moreover, unjust billing is not a victimless crime. As taxpayers, we all end up paying when Medicare is scammed. Additionally, unneeded services come with unneeded copays. 

If you suspect that your patient has been billed unnecessarily by another healthcare provider, you can encourage them to report it. Patients can report Medicare fraud here

Ever wonder what kinds of scams target doctors? Read about it on MDLinx. 

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