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.
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.
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 calls may seek to market insurance products or collect personal information from call recipients. 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” in calls they do make, as each local company must provide information that identifies its corporate or trade name in 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.
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)
- Mail Fraud (United States Postal Inspection Service)
- 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)