Healthcare Fraud Prevention and Reporting

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

Equally role of our mission to better and protect the healthcare system, the Blue Cross Blue Shield Association leads a national effort to prevent and answer to healthcare fraud that impacts members. The Blue Cantankerous 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 law-breaking nether most criminal codes, consisting of intentional cant for the purpose of illicit gains. Healthcare abuse is like activeness or beliefs 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'southward 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 increase medical payment
  • Misrepresenting the location where services or supplies are provided
  • Rendering medical intendance without a license
  • Duplicate merits submissions

How to Protect Yourself from Healthcare Fraud

Although healthcare fraud is committed by a very pocket-sized minority within the healthcare arrangement, no i can assume information technology 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 accurateness.
  • Ask your doctor to explain the reason for services.
  • Report any discrepancies to your wellness insurance program or payer.
  • Beware of "complimentary" medical services, every bit illicit entities utilise this lure to obtain data.
  • Safeguard your insurance member ID menu.
  • Study instances where co-payments or deductibles are waived.
  • Don't give your insurance number to marketers or solicitors.
  • Never sign a blank insurance class.

If you doubtable, experience or witness healthcare fraud, you lot should report the information to your local Bluish Cross Blue Shield company by calling the number on the back of your fellow member identification carte du jour. If you lot are not a BCBS fellow member you can e-mail the states or call the report fraud hotline 1-877-327-BLUE (2583). If y'all are a federal employee or retiree, you can written report potential healthcare fraud by calling ane-800-337-8440.

The study fraud hotline cannot address medical benefit questions, individual payment disputes, expiration of benefits or other administrative concerns.

Hands holding a smartphone with an unknown caller identity

Telephone Fraud Alarm

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 get in announced as if the telephone call is coming from the national "Call Blue" customer-service number (888.630.2583).  This number is merely used to receive calls from members, non to make calls, and if you receive a call that appears to be from 888.630.2583, the call is fraudulent or malicious and yous should not answer information technology, or hang upwards immediately after receiving it if you do answer the call initially.

Please click here to learn more well-nigh robocall scams and how yous can report fraud.

Robocall Scams

Blue Cross Blue Shield Association has received reports that some individuals are receiving robocalls that falsely claim to exist made by "Blue Cantankerous Blueish Shield."  These calls may seek to market insurance products or collect personal information from call recipients.  Neither Blue Cross Blue Shield Association nor whatsoever of the Blue Cantankerous 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 "Blueish Cross," "Blueish Shield" or "Bluish Cross Blue Shield" in calls they do make, as each local company must provide data that identifies its corporate or trade proper name in its communications (for instance, "Blue Cross and Blue Shield of [Land]").

If you get a recorded call from a caller whom you did non qualify to call you lot, the call is likely fraudulent or malicious and you should hang up immediately.  Do not reply to prompts to "press 1 to speak to the operator or go your proper name taken off the list," and do non provide any personal data.  If y'all reply, yous'll probably go more calls.  It is advisable to block the numbers of the robocalls you receive from calling your cell telephone, although these callers may proceed to call you lot from other numbers or use "spoofing" technology that makes the same calls appear to come up from different numbers.

To report malicious or doubtable robocalls and telemarketers, contact ane or all of the following 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 Criminal offence Complaint Heart (IC3) at https://world wide web.ic3.gov

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