You count on your health insurance to protect you—not put you at risk. But health care fraud can do exactly that. It can raise your costs, misuse your personal information, and even affect the care you receive. That’s why the DC Department of Insurance, Securities and Banking (DISB) encourages you to stay alert and take a few simple steps to protect yourself.
What Is Health Care Fraud?
Health care fraud happens when someone lies or uses false information to receive payment or benefits from a health insurance plan. This can involve charging for services you never received, billing for pricier procedures than those actually provided, or submitting multiple claims for the same visit. Providers, patients and even insurers can commit fraud.
Why It Matters
Health care fraud has real financial and personal consequences. The National Health Care Anti‑Fraud Association estimates that fraud costs consumers billions of dollars each year. In fiscal year 2025, federal investigators charged 324 individuals in schemes totaling more than $14.6 billion in fraudulent activity.
Fraud also leads to higher premiums, higher out‑of‑pocket costs, and reduced coverage—including for District residents. In some cases, dishonest providers perform unnecessary or unsafe medical procedures, and your personal or insurance information may be misused.
Protect Yourself
• Protect your insurance information. Share it only with trusted medical professionals.
• Be wary of offers for “free” services. If you're asked for insurance information, they may not be free.
• Check your Explanation of Benefits (EOB). Make sure the dates, providers, and services listed match the care you actually received. Report anything that seems off.
How to Report Fraud
If you think you’ve encountered health care fraud:
• Visit tips.fbi.gov to report it to the FBI.
• Contact DISB’s Enforcement and Consumer Protection Division at 202.727.8000.
Staying alert helps protect your wallet, your health, and your community. View more consumer alerts at disb.dc.gov/page/disb-consumer-alerts.