bcbs fraud department Protecting Patients from Waste and Abuse

The BCBS fraud department plays a crucial role in protecting patients from waste and abuse.

BCBS has a dedicated team of investigators who work tirelessly to identify and prevent fraudulent activities.

These investigators use sophisticated tools and techniques to analyze claims data and identify suspicious patterns.

They also collaborate with law enforcement agencies and other healthcare organizations to share intelligence and best practices.

By doing so, they can prevent millions of dollars in losses each year.

BCBS takes a proactive approach to preventing waste and abuse, which helps to keep healthcare costs low for patients.

This approach also ensures that patients receive the care they need without unnecessary delays or denials.

Healthcare fraud and abuse can take many forms, and it's essential to be aware of the risks to avoid being a victim.

Billing for services that weren't provided is a common example of healthcare provider fraud.

Duplicate submission of a claim for the same service is another way providers may commit fraud.

Billing for durable medical equipment items that weren't ordered or provided can also lead to financial losses.

Misrepresenting the service provided can result in incorrect payments and damage to your reputation.

"Upcoding" – charging for a more complex or expensive service than was actually provided – is a serious offense.

Here are some examples of member fraud and abuse:

Healthcare fraud is a serious crime that can result in fines or imprisonment of up to 10 years, or both. Making false or misleading statements on an application can carry a maximum five-year sentence.

Review your medical statement after each care visit to verify accuracy. This simple step can help you catch any discrepancies or errors.

Ask your doctor to explain the reason for services, so you understand what you're paying for. It's your right to know, and it can also help prevent misunderstandings.

Report any discrepancies to your health insurance plan or payer immediately. Don't assume someone else will take care of it.

Beware of "free" medical services, as illicit entities use this tactic to obtain information. It's a red flag that something might be off.

Safeguard your insurance member ID card and keep it in a safe place. This will prevent it from falling into the wrong hands.

Report instances where co-payments or deductibles are waived, as this can be a sign of fraud. Don't let it slide, even if it seems convenient.

Don't give your insurance number to marketers or solicitors, as this can compromise your information. Be cautious of unsolicited calls or emails.

Never sign a blank insurance form, as this can be a way for scammers to get you to commit to something you don't understand. Always read the fine print.

If you suspect, experience, or witness health care fraud or Medicare fraud, report it to your local BCBS company by calling the number on the back of your member identification card.

The Blue Cross Blue Shield Association (BCBSA) leads a national effort to prevent and respond to health care and insurance fraud impacting members. This effort is crucial in maintaining the public's confidence in the health care system.

Health care fraud hurts everyone, including patients, by compromising their health and safety. It also leads to higher premiums and increased out-of-pocket costs.

The BCBSA partners with state and federal agencies, as well as advocacy organizations, to report, investigate, and reduce the incidence of health care fraud. This collaboration is essential in identifying and prosecuting fraudulent activities.

You are a valuable ally in the fight against insurance fraud. Your tips can help BCBS companies do their job and prevent fraudulent activities.

Reporting health care fraud is a team effort. By working together, we can prevent fraudulent activities and ensure that everyone has access to secure health coverage.

Committing health care fraud is a serious offense with significant consequences. Health care fraud is both a state and federal offense.

If you're found guilty, you could face fines or imprisonment of up to 10 years, or both. The HIPAA Act of 1996 clearly outlines these penalties in (18USC, Ch. 63, Sec 1347).

Making false or misleading statements on an application can lead to a maximum five-year sentence.