Important Coronavirus/COVID-19 anti-fraud message to consumers
As part of our mission to improve and protect the healthcare system, particularly under the threat of the Coronavirus/COVID-19, the Blue Cross Blue Shield Association is focused on protecting members from fraudsters who seek to take advantage of the fear and confusion many feel surrounding the pandemic. 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.
- Be wary of advertisements for vaccinations or medications to treat the virus which are not recommended by the CDC, your local health department or your physician.
- Always be on the lookout for unexplained or unauthorized charges appearing on your Explanation of Benefits statement.
- Be aware of phishing and/or spear phishing emails referencing Coronavirus/COVID-19 which may contain malware and/or request your personal information.
- Be wary of advertisements offering health products that are ineffective against Coronavirus/COVID-19 i.e. herbal teas, supplements, oils or ointments. If you are uncertain, please seek guidance from your physician.
- Do not accept telemarketing or “Robo-Calls” from callers you did not authorize to call you. Nor should you accept unsolicited offers of telemedicine services not authorized by your health plan.
- Beware of door-to-door scams such as individuals knocking on your door offering to do Coronavirus/COVID-19 home examinations, which may include swab and vital signs testing, among others.
You are encouraged to visit and report incidents of fraud to any of these organizations:
FEDERAL BUREAU OF INVESTIGATION
- 1-800-447-8477 – Medicare Fraud
OFFICE OF PERSONNEL MANAGEMENT – OFFICE OF INSPECTOR GENERAL
CENTERS FOR DISEASE CONTROL
Beware of false unemployment benefit claims
The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, enacted by Congress to reduce the pandemic’s financial impact on U.S. citizens and businesses, inadvertently provided scammers an unprecedented opportunity to exploit the record number of unemployment benefits claims. Using stolen Personally Identifiable Information (PII), scammers filed false unemployment benefit claims, defrauding the U.S. government of hundreds of millions of dollars which created significant burdens on the individuals impacted. The FBI’s Economic Crimes Unit has advised that the hardest hit areas are currently in New England and the Pacific Northwest, and the states of Oklahoma and Ohio.
How to know if you are a victim:
- You attempt to file an unemployment claim and one already exists.
- You receive documentation from your state unemployment agency regarding a claim you did not file.
- You receive an IRS Form 1099G for unemployment benefits you did not request.
- Your employer notifies you that benefits were applied for in your name.
What to do if you are a victim:
- Contact your state unemployment agency and file a complaint. The procedures to file a complaint vary by state. To view your state, visit https://www.dol.gov/general/maps/fraud.
- File a report with your local police department.
How to further protect yourself:
- Get your free credit reports from annualcreditreport.com. Check for any accounts or charges you don’t recognize.
- Consider placing a free credit freeze. A credit freeze makes it harder for someone to open a new account in your name.
- If you place a freeze, be ready to take a few extra steps the next time you apply for a new credit card or cell phone – or any service that requires a credit check.
- If you decide not to place a credit freeze, at least consider placing a fraud alert.
- Continue to check your credit reports at annualcreditreport.com. You can order a free report from each of the three credit reporting companies once a year.
- Consider changing log-in and passwords for on-line banking, financial, utility, retail and social media accounts.
- Review your credit card accounts regularly. Review transactions to make sure no one misused your card. If you find fraudulent charges, call the fraud department to resolve them.
- Review bank account and other financial accounts regularly. If you find fraudulent transactions, call the fraud department to resolve them.
You can find more information at IdentityTheft.gov
Telephone Fraud Alert
We have received several complaints of an active fraud scheme in which a caller claims to be associated with “Blue Cross Blue Shield” and uses call spoofing technology to make it appear as if the call is coming from the national “Call Blue” customer-service number (888.630.2583). This number is only used to receive calls from members, not to make calls, and if you receive a call that appears to be from 888.630.2583, the call is fraudulent or malicious and you should not answer it, or hang up immediately after receiving it if you do answer the call initially.
Please click here to learn more about robocall scams and how you can report fraud.
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 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.
Blue Cross Blue Shield Association has received reports that some individuals are receiving robocalls that falsely claim to be made by “Blue Cross Blue Shield.” These callers may seek to market insurance products or collect personal information. Neither Blue Cross Blue Shield Association nor any of the Blue Cross and Blue Shield companies licensed to use the Blue Cross® and/or Blue Shield® brands are making these calls. Licensed Blue Cross and Blue Shield companies will not refer to themselves solely as “Blue Cross,” “Blue Shield” or “Blue Cross Blue Shield” when making calls to members. It is important to note that each local company must provide information that identifies its corporate or trade name in all of its communications (for instance, “Blue Cross and Blue Shield of [State]”).
If you get a recorded call from a caller whom you did not authorize to call you, the call is likely fraudulent or malicious and you should hang up immediately. Do not respond to prompts to “press 1 to speak to the operator or get your name taken off the list,” and do not provide any personal information. If you respond, you’ll probably get more calls. It is advisable to block the numbers of the robocalls you receive from calling your cell phone, although these callers may continue to call you from other numbers or use “spoofing” technology that makes the same calls appear to come from different numbers.
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:
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.
- Commercial and Public Health Care Fraud (Federal Bureau of Investigation)
- Medicare/Medicaid Health Care Fraud (Office of Inspector General, Department of Health and Human Services)
- Federal Employee Health Care Fraud (U.S. Office of Personnel Management)
- Using U.S. Postal Service for Post Office Fraud (United States Postal Service Office of Inspector General)
- Identity Fraud (Federal Trade Commission)
- National Health Care Anti-Fraud Association – A public/private partnership for healthcare fraud
- Casualty and Life Insurance Fraud (Coalition Against Insurance Fraud)