How can I recognize and report health care fraud?

Who is this for?

Michigan Health Insurance – Customer Service – How To

All Blue Cross Blue Shield of Michigan and Blue Care Network members.

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

Signs of fraud

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 can indicate fraud. If the date is wrong, or you see a service listed you didn’t get, consider reporting a suspicious EOB. 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 Fraud and Abuse page of the Official U.S. Government Site for Medicare 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 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.

Report fraud

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

  • 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 a form

Fax or mail

  • Fax 1-800-590-4616
  • Mail: Blue Cross Blue Shield of Michigan, Corporate and Financial Investigations, Department MC 1825, 600 E. Lafayette, Detroit MI 48226