How Can I Recognize and Report Health Care Fraud?

Health care fraud is a felony. It may be committed by Blue Cross members and health care professionals. The consequences of fraud include:

  • Endangering your access to your health insurance
  • Increasing insurance costs for everyone

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 when a doctor performs or orders unnecessary services to increase payments from the insurance company. Protect yourself and others by learning how to spot fraud.

Incorrect information on your explanation of benefits statement

If the date on your EOB is wrong, or you see a service listed that you didn’t get, this can indicate fraud. Consider reporting a suspicious EOB, because otherwise you could be paying for charges you shouldn’t have to pay.

Here are two tips to make this easier:

  • Track your doctor visits, including the dates and services you received. Later you can compare it to your EOB
  • Download the Blue Cross mobile app to keep track of your benefits and claims

Medicare fraud

Unfortunately, people have found many illegal ways to take advantage of Medicare. Visit the official U.S. government Medicare site to learn about Medicare fraud.

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.

When free isn’t

Health care providers who offer free services or waive your copay might not be giving you a bargain. Instead, they could be charging the insurance company more for other services to make up the difference, or adding on services you didn’t receive.

Thanks to members reporting fraud, Blue Cross has recovered more than $400 million. Here’s how you can contact us to report suspected fraud. Remember, all information is confidential.

Call us

Fax or mail

Fax to: 1-800-590-4616

Mail to:

Blue Cross Blue Shield of Michigan
Corporate and Financial Investigations
Department MC 1825
600 E. Lafayette
Detroit, MI 48226

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