What the Blues are Doing

In addition to the BCBSA National Anti Fraud Department (NAFD), each independent Blue Plan has its own anti-fraud unit.  Currently, there are over 600 employees performing anti-fraud work for the BCBS Plans.

The Blue Plans Investigators work along side Federal, State, and Local enforcement authorities responsible for investigating and prosecuting healthcare fraud and with other public/private fraud investigators and anti-fraud organizations.  An advisory committee of healthcare professionals provides insight and advice to anti-fraud investigators regarding current medical practices.

The NAFD operates the same healthcare fraud management for federal employees and retirees of the Federal Employee Program (FEP) as with the private sector program.

A Continuation of What the Blues Are Doing:

• Better use of computer and software technologies;
• Continuous assessment of emerging fraud trends and activities;
• Rapid deployment of preventive anti-fraud measures;
• Promoting best-in-class components for anti-fraud units;
• Establishing performance goals and benchmarks;
• Strike force investigations for large scale, multi-plan fraud activities;
• Creation of anti-fraud educational flyer;
• Operation of a national anti-fraud Hotline.