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How to recognize and report health care fraud

Who is this for?

Michigan Health Insurance – Customer Service – How To

If you suspect you’ve experienced or seen health care fraud, this information will explain how you can tell us about it.

Health care fraud doesn’t just cheat the system. It cheats you out of lower costs for insurance.

Sometimes fraud is easy to spot, like when someone steals your name and insurance information to get prescription drugs. Sometimes it’s not so easy, like a chiropractor who prescribes a back brace you don’t really need. 

These are real examples from Blue Cross Blue Shield of Michigan fraud case files that resulted in conviction because someone reported them.

Signs of fraud

Health care fraud is a felony that can endanger your health, your access to health insurance, and put your personal information at risk. Protect yourself and others by learning how to spot fraud.

Incorrect information on your Explanation of Benefit statement can indicate fraud, especially if the date is wrong or you see a service listed you didn’t get. It’s worth it to report a suspicious EOB. Otherwise you could be responsible for charges you shouldn’t have to pay.

Tip: Keep a personal log of your doctor visits, including the dates and services you received. That way you can compare it to your EOB.

Medicare fraud. Unfortunately, people have found many illegal ways to take advantage of Medicare. Visit the Fraud and Abuse page of the Official U.S. Government Site for Medicare to learn about Medicare fraud. The more you know, the easier it is to recognize and avoid it.

Guard your card. Loaning an insurance card or using an expired card to get medical care is fraud. So is keeping or putting someone on your contract who shouldn’t be there, like an ex-spouse.

Don’t rent when you can buy. If you’re renting durable medical equipment, like a wheelchair or respirator, make sure you know the purchase price of the equipment. The rental company can’t keep billing you once your total rental payments exceed what it would cost to buy the equipment.

When free isn’t. Health care providers who offer free services or waive your copay may not be a bargain. They may charge the insurance company more for other services to make up the difference, or add services you didn’t receive.

Can you hear me now? Learn how to hang up on telemarketers and telephone scams with these tips from our fraud investigation team.

Report fraud

You can help by reporting fraud. Thanks to you, our fraud investigation unit has recovered more than $300 million. Remember, information you give us about suspected fraud is confidential. We’ll never tell anyone that it came from you. 

  • Anti-Fraud Hotline: 1-800-482-3787
  • Medicare Anti-Fraud Hotline: 1-888-650-8136 (TTY users call 711)
  • Blue Cross Complete (Medicaid) Anti-Fraud Hotline: 1-855-232-7640

Fill out our online fraud report form.

Although everything you tell us is confidential, information submitted with this form isn’t secure or encrypted. If that worries you, you can call us, or mail or fax the form below.

Download, print and mail or fax our anti-fraud complaint form (PDF). You’ll see where to mail or fax the form when you open this document.

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