Healthcare Fraud Prevention and Reporting

Healthcare fraud hurts anybody. In addition to higher premiums and increased out-of-pocket costs, healthcare fraud compromises health and safety, which tin result in harm to patients, and undermines the public's conviction in the healthcare organization.

As part of our mission to improve and protect the healthcare arrangement, the Blue Cantankerous Bluish Shield Clan leads a national try to forestall and respond to healthcare fraud that impacts members. The Blueish Cross Bluish Shield companies partner with country and federal agencies, every bit well as advocacy organizations, to report, investigate and reduce the incidence of healthcare fraud.

What Is Healthcare Fraud?

Healthcare fraud is a federal offense under about 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 data to obtain services or supplies
  • Falsifying signatures or medical records to support misrepresented services or supplies
  • Unbundling services from a group to unlawfully increment 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 past a very small minority within the healthcare organization, no one tin assume it won't happen to them. We encourage you lot to take these steps to avoid becoming a victim of healthcare fraud:

  • Later on care, review your statement to verify accuracy.
  • Ask your md to explicate the reason for services.
  • Study whatsoever discrepancies to your health insurance plan or payer.
  • Beware of "free" medical services, every bit illicit entities use this lure to obtain information.
  • Safeguard your insurance fellow member ID menu.
  • Written report instances where co-payments or deductibles are waived.
  • Don't give your insurance number to marketers or solicitors.
  • Never sign a bare insurance class.

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 one-877-327-BLUE (2583). If you are a federal employee or retiree, yous tin study potential healthcare fraud by calling one-800-337-8440.

The study fraud hotline cannot accost medical do good questions, private payment disputes, expiration of benefits or other administrative concerns.

Hands holding a smartphone with an unknown caller identity

Phone Fraud Alarm

Nosotros have received several complaints of an agile fraud scheme in which a caller claims to be associated with "Blue Cross Blue Shield" and uses call spoofing technology to make it announced as if the call is coming from the national "Call Blue" client-service number (888.630.2583). This number is just used to receive calls from members, not to make calls, and if you receive a telephone call that appears to be from 888.630.2583, the call is fraudulent or malicious and y'all should non answer it, or hang up immediately after receiving it if you exercise respond the call initially.

Robocall Scams

Blue Cantankerous Bluish Shield Association has received reports that some individuals are receiving robocalls that falsely claim to exist made by "Blue Cross Blue Shield."  These calls may seek to market insurance products or collect personal data from call recipients.  Neither Blue Cross Blue Shield Clan nor any of the Blue Cross and Bluish Shield companies licensed to utilize the Blue Cross® and/or Blueish Shield® brands are making these calls.  Licensed Blue Cross and Blue Shield companies will not refer to themselves solely as "Blueish Cross," "Blueish Shield" or "Blueish Cross Blue Shield" in calls they practice make, as each local company must provide information that identifies its corporate or trade proper name in its communications (for instance, "Blueish Cantankerous and Blueish Shield of [State]").

If you get a recorded phone 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 non respond to prompts to "press one to speak to the operator or become your name taken off the list," and practice not provide any personal information.  If you reply, y'all'll probably get more than calls.  It is advisable to block the numbers of the robocalls yous receive from calling your cell phone, although these callers may continue to telephone call you from other numbers or use "spoofing" engineering science that makes the same calls appear to come from different numbers.

To written report malicious or suspect robocalls and telemarketers, contact one or all of the post-obit federal agencies:

  • The Federal Trade Commission at: https://ftc.gov/
  • The Federal Communications Commission at https://consumercomplaints.fcc.gov/hc
  • The Federal Bureau of Investigation, Internet Crime Complaint Center (IC3) at https://www.ic3.gov

The Bluish Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cantankerous and/or Blue Shield companies.