What is Double Billing in Healthcare?

Double billing is an unethical and illegal billing practice that unfortunately occurs far too often in the healthcare industry. It involves a healthcare provider attempting to collect payments twice for the same service rendered. This type of fraud drains billions from Medicare, Medicaid and private insurers each year.

For patients, double billing can lead to confusion, unexpected medical bills and credit damage. For providers, it can lead to harsh penalties, damaged reputations and even criminal charges if caught.

Let’s take a closer look at what double billing is, how it happens, and what can be done to stop it.

What Exactly is Double Billing?

Double billing refers to a healthcare provider submitting two claims for reimbursement for a single service provided. This can occur in several ways:

• Billing both Medicare/Medicaid and private insurance for the same procedure
• Billing the insurance company and the patient for the same procedure
• Submitting the same claim to the same insurer twice
• Two providers billing for the same procedure performed on the same patient on the same day
• Charging more than once for bundled services by using multiple billing codes

The key defining factor is that two or more claims are filed for one service rendered. The multiple claims may be totally identical or slightly altered in some way to avoid detection. Either way, it results in getting paid twice incorrectly.

Why Do Providers Double Bill?

Most double billing occurs intentionally as a fraudulent attempt to receive higher reimbursements. Some motives include:

• Greed – Unethical providers double bill simply out of greed and a desire to maximize profits. The more claims submitted, the more money collected.

• Make up for low reimbursements – Providers may feel Medicare/Medicaid reimbursements are too low, so they inflate claims to compensate.

• Hide in complex system – Large health systems make it easier to hide duplicative claims. The huge volume makes double billing harder to detect.

• Patient request – Providers may bow to patient pressure to bill both insurance and patient directly, even though it’s not allowed.

• Sloppy billing practices – Disorganized operations and lack of oversight can lead to accidental double billing.

While greed is the most common motive, the complexity of medical billing leaves the system vulnerable to inadvertent errors as well.

Examples of Double Billing

To understand double billing fully, it helps to look at some real-world examples:

• A hospital bills a patient’s health insurance for an appendectomy performed. The patient also receives a separate bill from the hospital requesting direct payment for the same appendectomy.

• A doctor’s office bills Medicare for a $150 office visit. The same office then bills the patient an additional $50 copay for that visit.

• A pathology lab bills an insurer $400 for a throat culture test. They later resubmit the same $400 claim, hoping the duplication goes unnoticed.

• A surgeon and anesthesiologist both bill Medicare $1000 each for the anesthesia during a surgery. Medicare should only pay one bill for the anesthesia.

• A dentist bills Medicaid $200 for a cleaning using code D1110. The dentist also bills Medicaid $150 for fluoride using code D1206, which already includes a cleaning.

In each case, providers are claiming double payments for a single service provided. These duplicate claims add up to billions in losses for government and private health plans.

Common Forms of Double Billing

Double billing can take many forms, but these are some of the most common schemes:

• Balance billing – Charging both insurer and insured for the same service
• Fee splitting – Two providers billing for the same procedure
• Unbundling – Billing for multiple codes instead of one bundled code
• Duplicate submission – Resubmitting the same claim multiple times
• Copy and paste – Photocopies or carbon copies of bills submitted as if original
• False dates – Slightly altering dates to hide duplication

Sophisticated operations may use altered patient names or ID numbers to further conceal the duplicate claims. But any two claims for one service constitutes improper double billing.

How Double Billing Cheats the System

To grasp the impact, it helps to see how double billing cheats the system and causes losses:

• Drains health plan funds – Every duplicated claim siphons away limited plan resources

• Higher premiums – Plans raise premiums to cover losses from fraud like double billing

• Incorrect copays – Wrong copay amounts collected from patients

• Phantom services – Paying twice makes it appear a service occurred twice

• Inaccurate records – Duplication corrupts medical history and claims data

• Unnecessary procedures – Providers create fake visits and services to inflate billing

Double billing forces health plans, employers and patients alike to pay millions for services that never actually happened.

Red Flags for Detecting Double Billing

Watching for telltale signs can help pay