GroupAccess > Fraud & Abuse > Identify Fraud & Abuse

 

Identify Healthcare Fraud & Abuse

Insurance fraud costs you money in the form of higher healthcare costs. In fact, losses to fraud account for an estimated 10% of what's spent on healthcare annually. At Blue Cross, our associates are dedicated to stopping fraud. However, we still need help from people like you.

Helping Blue Cross uncover fraud is easy. All you have to do is:

1. Know what to look for
2. Keep watch
3. Report suspected fraud and abuse

What to look for:

Common types of healthcare fraud include:

• Filing false claims or billing services that were not performed – when policy holders or medical care providers submit claims or bill services to receive payment for services that weren't provided.
• Including misleading information in an application for coverage – a person lies about a relationship to a contract holder or deliberately gives incorrect information to receive benefits not entitled to.
• Using ID cards that belong to someone else – using another person's ID card to receive or pay for services one isn't eligible for.

Keeping Watch:

• Read any Explanation of Benefits (EOB) you receive carefully
• Take note if you seem to be paying unusually high charges for regular services
• Understand what services your benefits cover

Report Suspected Fraud and Abuse:

We need your help in identifying cases of fraud and abuse. After all, only you know the services you received. If you see something on an Explanation of Benefits (EOB) that doesn't look right or if it lists a service you don't think was performed, contact your doctor or health care provider to question it. If you still have questions or concerns after talking to your provider, complete the online form to report suspected fraud and abuse or call our fraud hotline at:1-800-824-4391.