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Out of Network Medical Scams

July 1, 2016 by  
Filed under Blog

Over the course of investigating false insurance claims and insurance frauds, we have come to a simple conclusion; scammers will always keep coming up with new ways to defraud insurance companies. This fact is none more so evident that in medical insurance frauds.

Medical insurance fraud makes up a formidable chunk of the $80 billion insurance fraud losses in America. The worst part is that the policy holders aren’t the only ones trying to cheat their way towards a little extra money or treatment. The medical professionals are just as equally involves in the scams as the policy holders are. The latest scam making the rounds in hospitals and clinics across the nation is the “out of network” scam.

Out of Network

Creativity of medical professionals could be admired, regarding this scam, if it wasn’t so dishonest. The out of network medical scam allows clinics and hospitals an excuse to charge patients obscene amounts of money for regular medical procedures and medications. The shocking thing is that this practice isn’t exactly illegal, and many medical professionals are taking advantage of it.

The Scam

When you visit an insurance networked clinic, for a routine checkup or emergency situation, you will have to submit some paperwork. Most people don’t read the documents and sign them anyway, which leaves them vulnerable to this scam. After you leave the clinic, you will receive a large bill for the medical services of a doctor that you didn’t even know existed.

Sometimes your doctor will call someone in for a consultation or review your medical case, these out of network medical professionals take advantage of the situation and charge huge amounts of money for their “services” that you don’t even know that you have received.


This scam is becoming more and more popular because of its simplicity and ease at which it allows medical professionals to siphon off money from patients and insurance companies. But the popularity of the scam has also attracted the attention of the authorities to the scam and there are some actions being taken to resolve this loop hole in medical insurance policies.

To make sure that you don’t fall prey to such a scam, you should read the paperwork that you sign. And when you require the services of an insurance fraud investigator, you should remember who to call. We can help uncover the truth in the matter and make sure that we gather evidence that can be used in the court of law.


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