Learn How We Can Stop Injection Fraud Together

Many kinds of medical-based fraud harm countless individuals and organizations every year, but through vigilant knowledge and action, we can reduce that impact, including by reducing injection fraud.

At the 2024 Medical Fraud Academy & Workers’ Compensation Fraud Conference, CNA Insurance investigator Sam Schmidt spoke on the challenges posed by injection fraud. “You can go from a soft tissue claim to a claim that involves pain management injections, increasing their dollar amount significantly,” Schmidt said.

Fortunately, as Schmidt highlighted over the course of his presentation, with the right knowledge you can spot and fight injection fraud, as well as many other kinds of medical fraud.

What is Injection Fraud?

Injection fraud refers to several kinds of expensive medical procedures involving needle injections. Some joint injections relieve back and arthritic pains by inserting anesthetics and steroids into key joints of the body. Another kind of injection uses blood containing up to 10 times the normal amounts of platelets to support osteoarthritis, skin rejuvenation, and other forms of healing.

While sometimes those treatments are necessary, other times criminal medical providers and clinicians add these injections onto preexisting, less expensive treatments – both during medical operations and in billing – to sharply raise the overall medical bill.

Pain medication injections have always been a prevalent source for fraud, Schmidt explained, as criminals can quickly increase their overall profit while patients or insurance companies pay the price in high bills for treatment they may not have even received. That makes identifying injection fraud essential for both patients and medical fraud investigators.

Spotting Injection Fraud

Knowing the specifics for medical injection treatments helps investigators detect fraud, as investigators can spot abnormalities compared to normal treatments. Potential anomalies include injections that happen too frequently, as well as inappropriate documentation. “By knowing when we would expect to see those injections, how they’re performed, and the billing, we can identify fraud elements that aren’t supposed to be there, and have a better chance to mitigate those claims,” Schmidt said.

Many times, medical fraud starts with billing, so Schmidt advises patients to double check their billing and call their insurance provider if something doesn’t look right. “Take a close look at your bill,” Schmidt said. “Make sure that it’s something you went in for, that you saw a doctor on a certain date, that you had that injection or MRI.”

Moreover, identifying potential injection fraud may indicate additional kinds of medical fraud with the provider. Recognizing abnormal patterns signals investigators to dig deeper and potentially uncover larger criminal activities. “When you look at a provider across multiple claims and see that they continue to follow a pattern you wouldn't expect, you should dig a little bit deeper,” Schmidt said.

Building an Information Network to Fight Fraud

NICB’s Medical & Work Comp Fraud Conference and other training and networking opportunities support ongoing education for insurance investigators. Accessing knowledgeable professionals like Schmidt brings real experience and real trends to the conversations.

“Network opportunities are beneficial when everyone comes together to share information that they need as they review claims and identify different parts of a claims investigation,” Schmidt said. “Whether it’s medical information, legal information, or physical therapy, NICB gives you access to a wide variety of training from people within the industry.

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Visit our training calendar and register for upcoming opportunities online, via an instructor-led webinar, or in-person.