We look out for our members, and helping you get budget-friendly health care is part of our mission. One of the ways we keep your costs down is by working to stop fraud.
Fraud can have a big impact on costs. Why? Because when we pay claims that aren't valid, it drives up the cost of care for everyone.
What is health care fraud?
If someone intentionally misrepresents themselves to get health care, services, or payments they aren't entitled to, they're committing health care fraud.
Health care fraud is not only unfair and harmful – it’s also a crime. Health care fraud includes:
- Billing for care that wasn’t provided or for more expensive services than what someone got
- Billing services the plan doesn't cover as if it were covered
- Writing prescriptions that aren't needed
- Taking or giving bribes for care
- Selling prescriptions
- Stealing someone else's identity to get care or services covered
How do we fight fraud?
Our Special Investigations Unit (SIU) protects you by investigating fraud. Former law enforcement professionals and investigators make up the team, and they’re skilled at analyzing claims.
SIU works with members, Blue Cross employees, different health plans and other stakeholders to find and stop fraud. In some cases, our team works alongside local, state and federal law enforcement officers in their efforts to prosecute crimes.
You can fight fraud, too.
You’re an important part of the fight against fraud. Your tips can help us find fraud – and stop it. Here are a few things you can do to stop fraud:
- Look over any charges listed in your Benefit Summary. Let us know if it shows services you didn’t receive.
- Prevent identity theft by keeping your ID and insurance card safe. It’s also good to destroy your old ID cards.
If you notice something you think could be health care fraud, we’re here to help you. You can report fraud here. Or you can call our hotline at 1-888-343-4221.