We’re working to create awareness of fraudulent schemes and resources to report fraud

Our Corporate and Financial Investigations Unit conducts an annual fraud awareness campaign for employees each October — and this year, the unit is broadening its approach by reaching out to members and health care providers as well.

The goal of the campaign is to create awareness of fraud schemes and educate all stakeholders on how to recognize and report potential fraud, waste and abuse. Both our members and participating providers may become victims of fraud. For example, a member’s medical records may be affected by fraudulent claims activity.

DME fraud

One of the largest health care fraud schemes of the past year involves durable medical equipment fraud, costing the health care industry tens of millions of dollars a year. Since providers can be a victim of DME fraud, we reach out to providers whose NPIs are used without their knowledge. Providers may be approving DME without knowing the true cost charged to private insurers by DME companies.

“This is just one of the many ways we’re working to protect providers from becoming a victim of this and other fraud schemes,” said Daniel Crowell, senior director, Corporate and Financial Investigations.

Here’s an important guideline to keep in mind:

• DME is best suited for in-person visits, where devices can be properly fitted and assessed by the member’s provider.

Risk to members

Telemarketers sometimes market “free” DME to members, which results in high costs to insurers. Our Medicare members can be particularly susceptible to these schemes. Fraudulent telemarketers may reach out to seniors, intentionally confuse them and then get Medicare to pay for equipment that isn’t actually vetted by a medical professional.

Resources

• Contact CFI if you have concerns or recognize possible fraudulent activity. Call 1-844-STOP-FWA (1-844-786-7392) or send an email to StopFraud@bcbsm.com.
• Check out the Victimized Provider Project section** of the Centers for Medicare & Medicaid Services' website. The Victimized Provider Project helps keep providers from being held liable for overpayment for claims paid that are the result of identity theft.

By working together, we can help eliminate fraud, an effort that will improve patient safety and reduce costs.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.