Fraud & Abuse
Fraud is a major concern in the healthcare industry. It results in a loss of billions of dollars each year, and stress to consumers who are affected by it. Blue Cross is working to eliminate all instances of fraud that impact our customers, whether it is healthcare fraud, (e.g., filing false claims), or electronic fraud (e.g., fake emails and websites). Your help is needed in this effort. By reviewing the information provided and reporting any instances of suspected fraud, we can work together to ensure the security of our customers' information and control the rise of healthcare costs.
- Learn how to identify fraud and abuse
- Learn how to identify fraudulent emails
- Learn how to stop Medicare fraud
- Report suspected fraud and abuse
Tips to Prevent Fraud, Waste and Abuse
- Protect your Blue Cross and Blue Shield of Alabama (Blue Cross) contract number and your Social Security number. Protect your Blue Cross card like it's a credit card.
- Encourage the healthcare providers you see to request photo identification to avoid identity theft.
- Remember that nothing is ever "free." Don't accept offers of money or gifts for free medical care. If the care is truly free, then the provider should not ask for your insurance information. Often services touted as "free" are later billed to the insurance company and may or may not be covered.
- Be wary of providers who tell you that the item or service isn't usually covered, but they "know how to bill Blue Cross so the claim will pay." If they know the service is not covered then they should not submit the claim to Blue Cross.
- Don't let anyone persuade you to see a doctor for care or services you don't need. Ask your provider why you need testing before you agree to be tested. Ask your doctor if the tests are covered by your insurance.
- Ask your doctor if he is referring your lab work to in network laboratories. You may be charged a higher copayment and/or deductible for out of network providers.
- Don't be influenced by certain media advertising about your health. Many television and radio ads don't have your best interest at heart.
- Ask questions. You have a right to know everything about your medical care including the costs billed to your insurance company.
- Use a calendar to record all of your doctor's appointments and what tests or X-rays you get. Then carefully check your Explanation of Benefits (EOB) either on line or in the mail, to make sure you received each service listed and that all of the details are correct. If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct.
- Do report suspected instances of fraud by completing the online form or calling our fraud hotline at 1-800-824-4391. You can remain anonymous if you'd like but remember the more information you provide; the better Blue Cross can work to remedy the situation.