Reporting Healthcare Fraud
Blue Cross of Idaho is committed to doing all we can to prevent, detect and investigate healthcare fraud, waste and abuse by providers, brokers, employer groups or members. Blue Cross of Idaho has a special investigations unit dedicated to reviewing suspected instances of fraud. We encourage all members, groups, brokers and providers to report possible fraudulent activity through one of the following methods (you have the option to remain anonymous at all times):
Fraud Hotline: 800-682-9095
Common Types of Healthcare Fraud
Phantom Billing – Adding otherwise legitimate claim charges for services never performed or fabricating claims.
Upcoding – Charging for a more expensive service such as a visit to a specialist when the patient actually received service from a nurse or intern.
Doctor Shopping – Bouncing from one doctor to another to obtain multiple prescriptions for controlled substances.
Providing unnecessary care – Including unnecessary tests, surgeries and other procedures.
Misrepresenting services – Performing uncovered services but billing insurance companies for different services that are covered.
Unbundling – Charging separately for procedures that are actually part of a single procedure.
Masquerading as healthcare professionals – Delivering healthcare services without proper licenses.
Identity Theft – Using another person’s health insurance card or identification to obtain healthcare or other services or to impersonate that individual
Enrollment Fraud – Knowlingly misrepresenting health status or dependant status, or purposely failing to report a divorce or marriage of a dependant.
What YOU can do to prevent healthcare fraud
Protect your future healthcare options and those of your loved ones by looking out for fraud. To recognize scams you should:
- Be cautious of free medical exams, co-payment waivers, or advertisements stating “covered by insurance.”
- Protect your insurance ID card the same as you protect a credit card. Somebody could use your lost or stolen ID card to gain access to drugs and services that may permanently appear on your medical history
- Closely examine your Explanation of Benefits (EOB) from your health insurer to make sure the service billed was the service you or your family member received from a provider. If you have a question or discrepancy, contact Blue Cross of Idaho.