Hospital overcharged you? You're not alone. Four out of five medical bills contain errors averaging $1,300. Learn how to spot billing mistakes, dispute charges, and recover thousands.
Find out how likely your bill contains errors and estimate potential savings
A medical billing error is any mistake, inaccuracy, or fraudulent charge on a healthcare bill that causes you to pay more than you legally owe. These errors range from simple typos and duplicate charges to complex coding fraud and balance billing violations.
What makes billing errors so widespread? The U.S. medical billing system is mind-bogglingly complex. There are over 10,000 different procedure codes (CPT codes), 70,000 diagnosis codes (ICD-10), and countless insurance plan variations. Every healthcare encounter involves multiple people entering data - the provider, medical coder, billing specialist, insurance processor, and sometimes a third-party billing company. Each person who touches your bill is a potential source of error.
Some errors are honest mistakes—a tired billing clerk types the wrong code or accidentally enters a charge twice. But others are more problematic: aggressive "upcoding" where providers bill for more expensive services than they provided, "unbundling" where procedures that should be billed together are split apart to increase charges, or outright fraud where you're billed for services never rendered.
The financial impact is staggering. Studies estimate billing errors cost the U.S. healthcare system about $125 billion annually. For individual patients, errors on bills over $10,000 average about $1,300 in overcharges. That's money you shouldn't have to pay—and with a 78% success rate when patients dispute errors, it's worth fighting back.
The data on medical billing errors is alarming. Here's what the research shows:
These statistics reveal a systemic problem: the billing system is so complex that errors are the norm, not the exception. Yet most patients don't scrutinize their bills, so providers have little incentive to improve accuracy. When you dispute errors, you're not just saving money—you're forcing accountability.
Learn to recognize these frequent billing mistakes that cost patients billions annually:
Wrong name, birth date, policy number, or address causes insurance to deny the claim, leaving you with the full bill. This accounts for about 25% of billing errors.
You're charged twice (or more) for the same service, medication, or supply. Example: Daily medications charged multiple times on the same day, or the same lab test billed twice.
Billing for a more expensive service than what was actually provided. Example: You had a basic office visit but were billed for a comprehensive consultation. This is sometimes fraud.
Billing separately for services that should be packaged together. Example: A comprehensive metabolic panel should be one code, but you're charged for 14 individual blood tests at higher total cost.
An out-of-network provider charges you the difference between their rate and what your insurance paid. Now largely illegal under the No Surprises Act (effective 2022) for emergency care and certain other situations.
Charged for services, tests, or medications you never received. Always check the itemized bill against your memory and any discharge paperwork.
Wrong CPT (procedure) or ICD-10 (diagnosis) codes cause insurance denials. Example: The diagnosis code doesn't support the medical necessity of the billed procedure.
You're charged for appointments, procedures, or tests that were canceled or rescheduled but never performed.
Understanding the billing process helps you spot where errors creep in:
You receive medical care. The provider documents what was done in your medical chart.
A medical coder reviews your chart and assigns standardized codes: CPT codes (procedures), ICD-10 codes (diagnoses), HCPCS codes (supplies/services). ERROR POINT: Coder misreads chart or assigns wrong codes.
The billing department enters these codes into the billing system with prices. ERROR POINT: Data entry mistakes, duplicate entries.
A claim is sent to your insurance company with all the codes and charges. ERROR POINT: Wrong insurance info, missing required documentation.
Insurance reviews the claim and decides what they'll pay based on your plan. ERROR POINT: Insurance applies wrong plan rules, denies valid charges.
You receive an EOB showing what insurance paid and what you owe.
Provider sends you a bill for your portion. ERROR POINT: Provider bills you for amounts insurance already paid (balance billing), includes denied services you shouldn't pay for.
Each step is a potential error point. That's why cross-checking your bill, EOB, and medical records is essential.
Federal law now protects you from certain billing errors and surprise bills. Here's what you need to know:
Effective January 1, 2022, the No Surprises Act prohibits most surprise medical bills from out-of-network providers.
If you're uninsured or self-paying, providers must give you a "Good Faith Estimate" of costs at least 3 business days before services (or when you schedule, if sooner). If your actual bill is $400 or more higher than the estimate, you can dispute it.
Example: Your surgeon gave you a Good Faith Estimate of $8,000 for a procedure. The actual bill is $11,500—$3,500 more. Since that exceeds $400, you can dispute the excess. If you win, you only pay $8,400 (original estimate + $400).
Important: This only applies to Good Faith Estimate disputes. It doesn't cover all billing errors. Traditional disputes still require state-specific processes.
These landmark cases demonstrate the scope of medical billing fraud and the recoveries patients and government have achieved:
HCA Healthcare, one of the nation's largest hospital chains, settled allegations that it overbilled patients for emergency room services at Research Medical Center in Kansas City. The lawsuit claimed the hospital charged unconscionable prices, including $7,000+ for basic ER visits. The settlement provided refunds to 1,200+ patients. This case highlights how even major hospital systems engage in billing abuse and how collective action can force accountability.
Tenet Healthcare settled federal False Claims Act allegations that it systematically upcoded patient diagnoses to increase Medicare reimbursements. The scheme involved admitting patients to hospitals under inflated diagnosis codes to justify higher payments. Eight hospitals were involved, and the fraud lasted nearly a decade. The case was brought by whistleblowers under the qui tam provisions of the False Claims Act, who received $54 million of the settlement.
Community Health Systems paid $98.15 million to resolve False Claims Act allegations involving unnecessary cardiac procedures and implants. The case alleged physicians at CHS hospitals performed medically unnecessary procedures to boost billing. Additionally, CHS allegedly paid illegal kickbacks to referring physicians. This case demonstrates how billing fraud can directly harm patients through unnecessary medical interventions driven by profit motives rather than medical necessity.
UnitedHealthcare agreed to pay $1.5 billion to settle a class action brought by emergency medicine physicians over surprise billing practices. The lawsuit alleged UHC systematically underpaid out-of-network emergency providers, forcing those providers to balance bill patients. While this case was brought by providers, it highlights the insurance industry practices that generate surprise bills for patients. The No Surprises Act (2022) was partly a response to these widespread practices.
Anthem Blue Cross Blue Shield settled a class action alleging the insurer used a flawed database to calculate out-of-network reimbursements, resulting in patients facing higher balance bills. The lawsuit claimed Anthem knowingly used the Ingenix database despite knowing it was manipulated to show artificially low market rates. This underpayment scheme affected millions of patients who received surprise bills for the difference.
TeamHealth, one of the largest emergency medicine staffing companies, faces ongoing litigation in multiple states over surprise billing practices. Lawsuits in Texas, New York, and other states allege TeamHealth deliberately stays out-of-network with insurers to maximize balance billing opportunities. The Texas litigation alone involves thousands of patients who received massive surprise ER bills. State attorneys general have also investigated the company. These cases are ongoing, with some class actions pending and others reaching confidential settlements.
Multiple federal and state laws protect you from medical billing errors and fraud. Understanding these laws empowers you to assert your rights:
Effective January 1, 2022, this landmark federal law prohibits surprise billing for emergency services, certain non-emergency services at in-network facilities, and air ambulance transport. Key protections: patients can only be charged in-network cost-sharing for out-of-network emergency care; providers at in-network facilities cannot balance bill patients for inadvertent out-of-network care; uninsured patients must receive Good Faith Estimates, and can dispute bills $400+ over the estimate through the Patient-Provider Dispute Resolution (PPDR) process. Violations carry penalties of $400+ per patient. Enforcement by CMS and state insurance commissioners.
Requires hospital emergency departments to provide screening and stabilization regardless of ability to pay. While primarily focused on treatment obligations, EMTALA has billing implications: hospitals cannot demand advance payment before treating emergency conditions. They also cannot transfer patients for financial reasons before stabilization. Violation of EMTALA can support arguments against surprise emergency bills. Patients can report EMTALA violations to CMS, though private lawsuits are difficult. EMTALA establishes that emergency care must be provided, which underpins the No Surprises Act's emergency billing protections.
The ACA includes multiple billing protections: requires insurers to cover emergency services without prior authorization at in-network cost-sharing levels even if the hospital is out-of-network (this predated the No Surprises Act for insured patients); prohibits lifetime and annual limits on essential health benefits; requires coverage of preventive services without cost-sharing; and establishes internal and external appeals processes for claim denials. For billing disputes, the ACA appeals rights are critical—you can appeal denied claims internally and then to an independent reviewer if denied again.
Protects consumers from abusive debt collection practices, including medical debt collection. Key rights: debt collectors must send written validation notice within 5 days of first contact; you have 30 days to dispute and demand verification; collectors must cease collection during verification; they cannot call before 8am or after 9pm, call repeatedly to harass, use false statements, or threaten illegal actions; you can send a cease communication letter requiring them to stop contact. Violations can be sued for up to $1,000 statutory damages per violation plus actual damages and attorney fees. The FDCPA is one of the most powerful tools against aggressive medical debt collection.
Regulates how medical debt is reported to credit bureaus and gives you rights to dispute inaccurate information. 2022 amendments specific to medical debt: medical collections under $500 are excluded from credit reports; medical debt cannot be reported until 1 year after it's placed with a collection agency (previously 6 months); paid medical collections must be removed from credit reports. You have the right to dispute inaccurate medical debt with credit bureaus, who must investigate within 30 days. If they fail to correct inaccurate information, you can sue for statutory damages of $100-$1,000 per violation plus actual damages and attorney fees.
Compare medical billing protections and dispute processes across different regions
Everything you need to know about medical billing errors and disputes
78% of disputes succeed. Don't let billing errors cost you thousands. Check your bill for errors and start your dispute today.
Pet died at the vet clinic? Insurance denied your claim? Thousands in bills? German law protects pet owners. Free Ombudsman services, malpractice claims, fee disputes. Complete guide to your rights.
EEOC recovered $700M for 21,000 workers in FY2024. 97% litigation success rate. Free filing, no lawyer needed, 180-300 day deadline. Complete guide to filing discrimination charges and getting compensation.
$328M New York. $175M Massachusetts. $19.4M New Jersey. California case worth billions. How Uber and Lyft stole wages through misclassification. Claim deadlines, eligibility, and how to file.
Workday lawsuit certified as nationwide class action. iTutorGroup $365K settlement. HireVue discriminates against deaf applicants. 83% of companies use AI to screen resumes. Your rights when algorithms discriminate.
Workday AI rejected 1.1 billion applications. Class action now covers millions. EEOC rolled back guidance but laws still apply. Complete guide to fight AI hiring bias.
$140B in medical debt affects 100M Americans. CFPB rule struck down July 2025. No Surprises Act still protects. Complete guide to dispute bills, protect credit, fight collectors.