Health Care Fraud

Billions of dollars in health care fraud occur each year. The crime, which is predicted to become even more common in the future, includes everything from health care identity theft to billing for health care services that were never performed. Losses from health care fraud lead to increased health care costs, which can make care more expensive for all of us. National estimates project that billions of dollars are lost to health care fraud and abuse on an annual basis.

Examples of Health Care Provider Fraud & Abuse include:

• Billing for services that were not provided
• Duplicate submission of a claim for the same service
• Billing for durable medical equipment items that were not ordered or provided
• Misrepresenting the service provided
• "Upcoding"—Charging for a more complex or expensive service than was actually provided
• Billing for a covered service when the service actually provided was not covered

Examples of Member Fraud & Abuse include:

• Using a member ID card that does not belong to that person
• Adding someone to a policy that is not eligible for coverage
• Failing to remove someone from a policy when that person is no longer eligible
• Forging or altering bills
• Misrepresenting physical conditions or medical history in order to obtain multiple prescriptions

Health Care Fraud & Abuse Prevention Tips

At Blue Cross Blue Shield of Massachusetts, we are working hard to prevent and deter fraud, waste, and abuse, but we need your help. Simple tips that may help you prevent fraud and abuse include:

• Never share your insurance card with another person. Protect it like you would a credit card.
• Check your claims history logging into your account at Member Central to verify that you received the services listed.
• Report suspected fraud and abuse as soon as possible.

How to Report Suspected Fraud and Abuse

Please choose any one of the three options listed below: