Did you know that healthcare fraud costs U.S. taxpayers billions of dollars every year? Beyond the staggering financial implications, these schemes can disrupt the quality of care that patients receive, impacting the trust we place in our healthcare system.
While healthcare fraud can go undetected for years, healthcare and medical billing professionals have the unique opportunity to identify suspicious activities and take action to address them.
In this article, we’ll explore five of the biggest healthcare fraud schemes to be aware of in 2025, and how to recognize these deceptive practices and discover the steps you can take to confront them confidently.
The Biggest Healthcare Fraud Schemes to Watch for in 2025
Healthcare fraud can take many forms, but some schemes are becoming increasingly prominent in the industry. Here are the top five schemes to watch for this year.
1. Podiatry & Skin Graft Fraud
Podiatrists play an essential role in treating chronic wounds and preventing serious complications, such as infections and amputations. However, some dishonest practitioners misuse expensive skin graft materials in a practice called “harvesting.”
Rather than using a single skin graft as intended, a physician might divide the graft into smaller portions to use on multiple patients, while billing each patient’s insurance for full grafts. This type of billing fraud not only exploits resources, but may also shortchange patients on the care they deserve.
How to Spot It: Keep a close eye on discrepancies between the use of skin graft materials and patient billing records. If you see evidence that patients are being charged for a single-use graft when only a small amount was applied, this could be a red flag.
2. Home Care & Hospice Fraud
Home care and hospice services are designed to provide compassionate care for patients who are elderly, disabled, or terminally ill. Unfortunately, bad actors can exploit these programs by enrolling patients who don’t qualify or billing Medicare for services that were never provided.
How to Spot It: Monitor for unusually high numbers of new patients, particularly if they don’t appear to meet the qualifications for care. Additionally, look for claims for services that were never actually delivered.
3. Sponsored Genetic Testing Fraud
Genetic testing has become a valuable tool for early diagnosis and preventative care. However, fraudulent labs and pharmaceutical companies may exploit this growing demand by sharing information on patients that test positive. This info should only be shared with the patients.
How to Spot It: Look for signs that patient information is being improperly shared between testing labs and pharmaceutical companies, especially if it leads to drug referrals. Additionally, watch for unusually close relationships between drug reps, doctors, and testing providers that could indicate kickback schemes.
4. Respiratory Fraud
Respiratory care includes essential treatments for patients with conditions like asthma, COPD, or sleep apnea. Fraudulent activity in this area often involves overbilling for respiratory treatments or submitting claims for unnecessary or unused durable medical equipment (DME), such as oxygen CPAP /BiPAP or Non-Invasive ventilator devices.
How to Spot It: Review billing patterns. Are there repeated claims for treatments or devices that patients didn’t need, use, or receive? These types of irregularities could signal fraud.
How to Respond If You Suspect Healthcare Fraud
If you recognize any of these warning signs in your workplace, don’t worry—you’re not alone. There are straightforward steps you can take to address healthcare fraud and protect patients, while strengthening the integrity of the system.
Step 1: Document Everything
Begin by keeping detailed notes on what you observe. Save copies of billing codes, patient records, and any communication logs that highlight irregularities. This documentation can help confirm your suspicions and form the foundation of a strong case.
Step 2: Avoid Sharing Your Suspicions
While it might be tempting to talk about your concerns with coworkers, supervisors, or others, keeping the matter private is key. By maintaining confidentiality, you protect the integrity of your findings and prevent accidental interference with an investigation.
Step 3: Contact a Whistleblower Law Firm
A trusted whistleblower law firm can guide you every step of the whistleblowing process. At DJO Whistleblower Law Firm, our team of experienced attorneys will help you file claims correctly, ensure your rights are protected, and make the process as seamless as possible.
Step 4: Act Quickly
Fraudulent activities cost taxpayers and patients every day they go unreported. Acting promptly not only prevents further harm, but also increases your chances of being eligible for a substantial reward. Under the False Claims Act, whistleblowers can receive up to 30% of any funds recovered by the government, making your efforts both impactful and potentially rewarding.
Do You Suspect Healthcare Fraud in Your Workplace?
From podiatry skin graft harvesting to unnecessary hospice enrollments and fraudulent genetic testing, healthcare fraud remains a pressing issue in 2025. These illegal practices waste valuable resources, harm patients, and erode trust within the industry. But you can help combat them!
By staying vigilant, recognizing the signs of fraud, and seeking guidance from a reliable whistleblower law firm, you can play a vital role in protecting patients and the healthcare system at large.
If you’ve seen signs of healthcare fraud in your workplace, don’t hesitate. Your courage could recover stolen taxpayer dollars, improve the quality of care, and hold fraudulent practitioners accountable.
Contact DJO Whistleblower Law Firm today for a free, confidential consultation. Your actions could make all the difference, not just for patients, but also for the future of ethical healthcare.
authored by Christopher J. Piacentile
Director of Investigations DJO Whistleblower Law Group
