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WHAT IS HEALTH CARE FRAUD?








Health care fraud is a serious business in the U.S. — and a serious crime.

There are many different kinds of health care fraud. Common examples include:

 * Using an expired or fraudulent identification card to get medical services or
   medications 
 * Lending an ID card to someone who isn't entitled to it 
 * Adding someone who isn't eligible for coverage to a contract 
 * Providers who bill for services never rendered 
 * Performing medically unnecessary services to receive payment from insurers
 * Billing for more expensive services or procedures than were actually
   provided 
 * Accepting kickbacks for patient referrals 





HOW FRAUD IMPACTS YOU

For consumers, health care fraud equals higher premiums and out-of-pocket costs,
and reduced benefits and coverage. Fraud also hurts employers by driving up the
costs of providing benefits to employees and doing business.

Estimates put the amount lost to health care fraud at between 3 and 10 percent
of overall health care spending — between $68 billion and $226 billion. With
health care costs on the rise, the price tag for fraud is likely to climb unless
efforts to combat it are successful.


FRAUD CARRIES OTHER IMPLICATIONS FOR VICTIMS. YOU COULD:


 * Be subjected to unnecessary or unsafe medical procedures or treatments
 * Find that your insurance benefits have unexpectedly been exhausted
 * Have erroneous information added to your medical records
 * Receive the wrong medical treatment
 * Unexpectedly fail a physical examination for employment
 * Be deemed uninsurable as a result of medical identity theft

 




IF YOU SUSPECT FRAUD:

Report it immediately ▸

You can call us from 8:30 a.m. to 4:30 p.m. Monday through Friday.

You can also leave a message after hours. A fraud specialist will return your
call the next business day to collect further information.

Blue Cross Warns Members of Phone Scams

How to recognize fraud

Fraud Hotline
1-800-482-3787




Medicare Fraud Hotline
1-888-650-8136




Blue Cross Complete of Michigan (Medicaid)
Fraud Hotline
1-855-232-7640




TTY users
To reach any number listed here, start by dialing 711.






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