misbilling

Misbilling refers to the act of invoicing or charging for goods or services in a way that is incorrect or inappropriate. It can involve charging for services not performed, charging the wrong price, or duplicating charges, and it can occur in many industries, including healthcare, utilities, telecommunications, retail, insurance, and government programs. Misbilling can result from unintentional errors or deliberate deceit. When it is intentional, it is often described as fraud or theft of services; when unintentional, it is commonly treated as an administrative error or overbilling.

In healthcare, misbilling is a common term and can take several forms: upcoding, where a higher-paying service is billed than was delivered; unbundling, where components of a service are billed separately rather than as a bundled package; duplicate billing; balance billing; and billing for services not rendered or not medically necessary. In other sectors, misbilling can include duplicate charges, incorrect tax calculations, misapplied discounts, or charging higher rates than contracted.

Impacts of misbilling include financial losses for patients, providers, and payers; compliance jeopardy and potential penalties from regulators; reputational damage; and administrative burdens such as audits and dispute resolution. Detection often relies on automated controls in billing systems, routine audits, reconciliations, and staff training. Remedial actions may include refunds or credits, process corrections, enhanced verification steps, and whistleblower reporting channels. In many jurisdictions, deliberate misbilling is illegal and subject to civil or criminal penalties, while inadvertent misbilling may be addressed through corrective action and remediation.