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Healthcare Fraud

Understanding Healthcare Fraud

Patients and their medical insurance information can be exploited in various ways that result in increased costs and decreased confidence in the healthcare system. As part of our efforts to improve and protect the healthcare system, the Blue Cross and Blue Shield National Anti-Fraud Department is undertaking a nationwide campaign to share how physicians, healthcare providers and customers can help with healthcare fraud detection and prevention.

Protect Yourself  

We encourage you to follow these general guidelines to safeguard yourself from preventable medical errors and improve the quality of care you receive.

  1. After care, review your statement to verify accuracy. Learn how to read your Explanation of Benefits.
  2. Ask your doctor to explain the reason for services
  3. Report any discrepancies to your health insurance plan or payer
  4. Beware of "free" medical services, as illicit entities use this lure to obtain information
  5. Safeguard your insurance card the same as you would your credit card
  6. Report instances where co-payments or deductibles are waived
  7. Don’t give your insurance number to marketers or solicitors
  8. Never sign a blank insurance form

Report Fraud

If you suspect that healthcare dollars are being paid improperly or as a result of false or misleading information provided to a Blue Cross and Blue Shield company, notify your local Blue Cross and Blue Shield company.Our Partners

Federal Bureau of Investigation

Office of Inspector General
Department of Health and Human Services

Office of Inspector General
Office of Personnel Management

Office of Inspector General
U.S. Postal Service

Federal Trade Commission

U.S. Postal Inspection Service

Food and Drug Administration
Department of Health and Human Services

Office of Inspector General
Department of Labor

National Health Care Anti-Fraud Association

Coalition Against Insurance Fraud

Association of Certified Fraud Examiners

State Attorneys General

State Departments of Insurance

State and Local Police Departments White Collar Crime Units

State Medical Licensing and Disciplinary Boards