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.
Report Healthcare Fraud
If you suspect, experience or witness healthcare fraud, immediately report an incidence of fraud to your local Blue Cross Blue Shield company. You can email us or call the antifraud hotline 1-877-327-BLUE (2583), and you are also encouraged to report fraud incidence with our partners.
If you are a federal employee or retiree, you can report potential healthcare fraud by calling 1-800-337-8440.
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.
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)