Health care fraud hurts everyone. In addition to higher premiums and increased out-of-pocket costs, health care fraud compromises health and safety, which can result in harm to patients, and undermines the public's confidence in the health care system.
As part of our mission to improve and protect the health care system, the Blue Cross Blue Shield Association (BCBSA) leads a national effort to prevent and respond to health care and insurance fraud impacting members. Blue Cross and Blue Shield (BCBS) companies partner with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of health care fraud.
Health care fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Health care abuse consists of similar activity or behavior, but the intent to obtain an unlawful gain cannot be established. Some examples of health care fraud and abuse include:
Although medical insurance and health care fraud are committed by a very small minority within the health care system, no one should assume it won't happen to them. We encourage you to take these steps to avoid becoming a victim of health care fraud:
If you suspect, experience or witness health care fraud or Medicare fraud, you should report the information to your local BCBS company by calling the number on the back of your member identification card. If you are not a BCBS member you can call the report fraud hotline 1.877.327.BLUE (2583). If you are a federal employee or retiree, you can report potential health care fraud by calling 1.800.337.8440.
The report fraud hotline cannot address medical benefit questions, individual payment disputes, expiration of benefits or other administrative concerns.
We have received several complaints of an active fraud scheme in which a caller claims to be associated with “Blue Cross Blue Shield” and uses call spoofing technology to make it appear as if the call is coming from the national “Call Blue” number (888.630.2583). This number is only used to receive calls from members, not to make calls, and if you receive a call that appears to be from 888.630.2583, the call is fraudulent or malicious and you should not answer it or hang up immediately.
BCBSA has received reports that some individuals are receiving robocalls that falsely claim to be made by “Blue Cross Blue Shield.” These calls may seek to market insurance products or collect personal information from call recipients. Neither BCBSA nor any of the BCBS companies licensed to use the Blue Cross® and/or Blue Shield® brands are making these calls. Licensed BCBS companies will not refer to themselves solely as “Blue Cross,” “Blue Shield” or “Blue Cross Blue Shield” in calls they do make, as each local company must provide information that identifies its corporate or trade name in its communications (for instance, “Blue Cross and Blue Shield of [State]”).
If you get a recorded call from a caller you did not authorize to call you, the call is likely fraudulent or malicious and you should hang up immediately. Do not respond to prompts to “press 1 to speak to the operator” or “get your name taken off the list,” and do not provide any personal information. If you respond, you’ll probably get more calls. It is advisable to block the numbers of the robocalls you receive from calling your cell phone, although these callers may continue to call you from other numbers or use “spoofing” technology that makes the same calls appear to come from different numbers.
To report malicious or suspect robocalls and telemarketers, contact one or all of the following federal agencies:
BCBS companies work closely with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of insurance and health care fraud. You are encouraged to visit and report fraud incidents with any of these organizations.