3 Unethical Medical Billing Behaviors to Avoid

Medical billing is a complex and often confusing process. It can be difficult to know what is allowed and what is not. This post discusses three of the most common unethical medical billing practices: phantom charges, duplicate billing, and upcoding. It explains what these practices are, why they are wrong, and how to avoid them.

Phantom Charges

Phantom charges appear on a patient’s bill for services or products that were not received or never ordered.

This can be an extremely frustrating experience for patients, who may end up paying for services they did not receive or products they never ordered. Phantom charges can also be difficult to spot and challenging to dispute.

Phantom charges can occur in a few different ways, and overbilling is one. Sometimes the medical biller will include services or products not rendered to increase profits.

To avoid phantom charges, always ask your provider to break down the cost of each service before you receive it. If something doesn’t seem right, make sure to follow up with it before you make the charge.

Duplicate Billing

Unfortunately, duplicate billing is another common unethical medical billing practice. Duplicate billing occurs when a patient is billed twice for the same service or product.

There are several reasons why duplicate billing can occur. One common reason is when providers bill both the patient and the insurance company for the same service. This often leads to patients being overcharged or even denied coverage for services.

Another common reason duplicate billing occurs is that providers sometimes bill different insurance companies for the same service. This can create confusion and result in patients being billed multiple times for the same service.

Always verify with your provider that they will be billing your insurance company for the services you receive to avoid duplicate billing.

Upcoding

Upcoding is a practice that providers often use to increase their profits. Upcoding occurs when a provider bills for a service or product higher than was provided.

This can lead to patients being overcharged for services they did not need or products they didn’t order.

Upcoding may occur when providers bill for more expensive procedures than were performed. This can be done to receive more money from the insurance company. It can also occur when providers bill for unnecessary or even used services.

You can always ask your provider to break down the cost of each service before you receive it. This will help you identify any potential upcoding scams.

Tri Smith, Instructor

Tri Smith is a Managing Partner and Instructor at MedicalBillingCourse.com, where he leads both the strategic direction and instructional delivery of the program. With over six years of experience, he works closely with students and internal teams to ensure the course remains aligned with real-world medical billing practices while continuing to evolve with industry needs.

His work focuses on guiding learners through the full medical billing lifecycle, from foundational processes to more advanced topics such as claim accuracy, payer communication, and compliance. He is directly involved in how the course is structured, how assessments are designed, and how students are supported as they progress from training into practical application.

Under his leadership, MedicalBillingCourse.com launched the 2026 edition of the course, which includes the new Medical Billing and Coding certification track and reflects a more modern, structured approach to training. These updates emphasize clarity, real-world readiness, and scalable learning systems that support both new students and returning graduates.

Tri has helped thousands of students complete their certification and move into roles ranging from remote billing positions to in-office healthcare settings and independent billing businesses. His approach emphasizes practical execution, consistent standards, and the ability to turn training into a real opportunity.