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.

Robocall Scams
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.

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.