What is Double or Duplicate Billing in Medical Billing?

When working in the Medical field, one of the biggest challenges is understanding the Medical Billing Terminology associated with each part of the process.

One confusing term that is often used by insurance providers is ‘Double Billing’

What is the definition of Double or Duplicate Billing in Medical Billing Terms?

“Double billing” (sometimes referred to as Duplicate Billing) occurs when a provider attempts to bill Medicare / Medicaid and either a private insurance company or the patient for the same treatment, or when when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date. 

Double billing also occurs when a provider attempt to charge more than once for the same service, for example by billing using an individual code and again as part of a bundled set of tests.

This type of fraud typically involves sending a bill to both Medicaid and a private insurance company, or even the patient. In some cases, two providers will ask for payment on the same recipient for the same procedure on the same date.

In some cases, double billing may occur because the  provider is unaware of the process, or has not checked if the procedure has already been billed.

For example: a doctor or nurse can be at fault for this billing mistake when both request that a patient be charged for a prescription or service.

Is double billing or duplicate billing illegal?

If the double or duplicate billing is intentional, then it is a form of fraud.

According to legal firm Brewer and Pritchard “Medicaid fraud involving double billing for medical services happens far more often than many people might realize.

“Health care professionals who try to commit this form of fraud often believe they can do so because Medicaid handles so many claims throughout the country.”