Healthcare Fraud | Blue Cross Blue Shield

Healthcare Fraud Prevention and Reporting

Healthcare fraud hurts everyone. In addition to higher premiums and increased out-of-pocket costs, healthcare fraud compromises health and safety, which can result in harm to patients, and undermines the public's confidence in the healthcare system.

As part of our mission to improve and protect the healthcare system, the Blue Cross Blue Shield Association leads a national effort to prevent and respond to healthcare fraud that impacts members. The Blue Cross Blue Shield companies partner with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of healthcare fraud.

What Is Healthcare Fraud?

Healthcare fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Healthcare abuse is similar activity or behavior where knowing intent to obtain an unlawful gain cannot be established. Some examples of healthcare fraud and abuse include:

  • Phantom claims for services or supplies that were never provided
  • Using someone else’s medical insurance information to obtain services or supplies
  • Falsifying signatures or medical records to support misrepresented services or supplies
  • Unbundling services from a group to unlawfully increase medical payment
  • Misrepresenting the location where services or supplies are provided
  • Rendering medical care without a license
  • Duplicate claim submissions

How to Protect Yourself from Healthcare Fraud

Although healthcare fraud is committed by a very small minority within the healthcare system, no one can assume it won't happen to them. We encourage you to take these steps to avoid becoming a victim of healthcare fraud:

  • After care, review your statement to verify accuracy.
  • Ask your doctor to explain the reason for services.
  • Report any discrepancies to your health insurance plan or payer.
  • Beware of "free" medical services, as illicit entities use this lure to obtain information.
  • Safeguard your insurance member ID card.
  • Report instances where co-payments or deductibles are waived.
  • Don’t give your insurance number to marketers or solicitors.
  • Never sign a blank insurance form.

If you suspect, experience or witness healthcare fraud, you should report the information to your local Blue Cross Blue Shield company by calling the number on the back of your member identification card. If you are not a BCBS member you can email us or call the report fraud hotline 1-877-327-BLUE (2583). If you are a federal employee or retiree, you can report potential healthcare fraud by calling 1-800-337-8440.

The report fraud hotline cannot address medical benefit questions, individual payment disputes, expiration of benefits or other administrative concerns.

Telemarketers and Phishing Scams
Telemarketer robocalls and phishing scams have become common and are an improper way to collect your personal healthcare information.  Blue Cross Blue Shield representatives do not make cold calls, and they never ask for personal information.

If you get a recorded sales call, but you didn’t give the caller written permission to call you, the call is illegal.  Don’t press 1 to speak to the operator or get your name taken off the list, and don’t give any personal information.  If you respond, you’ll probably get more calls.  You can also block these calls from your cell phone.

If you want information about health insurance in your state, visit HealthCare.gov.  To report malicious or suspect robocalls and telemarketers, contact one or all of the following federal agencies:

Our Partners

The Blue Cross Blue Shield companies work closely with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of healthcare fraud. You are encouraged to visit and report fraud incidents with any of these organizations.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.