Jane Dotson
Medical insurance fraud is a serious issue that affects everyone and causes billions of dollars in losses each year. It occurs when individuals or entities deceive the system for illicit gains, such as billing for services never provided or obtaining someone else's medical insurance information. To combat this, organizations like the FBI, Blue Cross Blue Shield, and the National Insurance Crime Bureau work to investigate and reduce fraud. They provide resources and hotlines for individuals to report suspicious activities and protect themselves from becoming victims. It is important for people to be vigilant, safeguard their personal information, and regularly review their medical statements to identify and report any discrepancies or signs of fraud.
| Characteristics | Values |
|---|---|
| Reporting Instance | Contact the Federal Bureau of Investigation (FBI) or the Office of Inspector General (OIG) Hotline |
| Who to Report | Report malicious callers, telemarketers, robocalls, and scammers |
| Prevention | Protect your health insurance information, treat it like a credit card, and do not give it to others to use |
| Be mindful when using your insurance at the doctor's office or pharmacy | |
| Beware of "free" services and always check your explanation of benefits (EOB) | |
| Do not give your insurance number to marketers or solicitors | |
| Do not sign a blank insurance form | |
| Review your statement to verify accuracy and ask your doctor to explain the reason for the services | |
| Report any discrepancies to your health insurance plan or payer | |
| Report instances where co-payments or deductibles are waived | |
| Do not respond to prompts to "press 1 to speak to the operator" or "get your name taken off the list" | |
| Block the numbers of robocalls and malicious callers | |
| Compare the dates and services on your calendar with the Medicare statements you get to make sure you got each service listed and that all the details are correct | |
| Learn about Medicare and recent scams | |
| Protect your Medicare Number and your Social Security Number | |
| Check the receipts and statements you get from providers for mistakes | |
| Report Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227) or the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379) |
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What You'll Learn
Report to Blue Cross Blue Shield (BCBS) or a similar company
If you are a member of Blue Cross Blue Shield (BCBS), you can report suspected fraud by calling the number on the back of your member identification card. You can also report online or by downloading and submitting a form in PDF format. BCBS also has a fraud hotline: 1.877.327.BLUE (2583). If you are a federal employee or retiree, you can report potential health care fraud by calling 1.800.337.8440.
BCBS has a zero-tolerance policy for fraud and abuse and is committed to addressing and minimizing fraudulent activity. The company works with law enforcement and seeks criminal prosecution through the courts when criminal activity has been identified. BCBS also partners with state and federal agencies, as well as advocacy organizations, to report, investigate, and reduce the incidence of health care fraud.
Healthcare fraud includes everything from healthcare identity theft to billing for healthcare services that were never performed. It also includes phantom claims for services or supplies that were never provided, and using someone else's medical insurance information to obtain services or supplies.
If you are not a BCBS member, you can still report suspected fraud to the company. BCBS has a confidential reporting policy that enforces non-retaliation and non-intimidation against those who report potential concerns. You can remain anonymous or include your contact information.
Additionally, you can report suspected fraud to the appropriate government agency, such as the Federal Bureau of Investigation (FBI) for commercial and public healthcare fraud, or the Office of Inspector General, Department of Health and Human Services, for Medicare/Medicaid healthcare fraud.
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Contact the FBI
The FBI is the primary agency for investigating healthcare fraud for both federal and private insurance programs. If you suspect medical insurance fraud, you can contact the FBI in the following ways:
Firstly, you can call the FBI on 1-800-CALL-FBI (1-800-225-5324). This number is staffed by a team of FBI employees 24 hours a day and is designed to receive urgent and non-urgent tips. You can also submit a tip electronically via the FBI's website. The FBI also has a number of field offices across the United States which can be contacted via phone or email.
If you are a victim of medical insurance fraud, it is important to provide as much information as possible when contacting the FBI. This includes the date and time of the incident, the location, the names of any individuals involved, and any other relevant details. It is also helpful to provide any documentation or evidence that supports your claim, such as medical records, insurance statements, or correspondence with the healthcare provider.
In addition to contacting the FBI, you may also want to consider reporting the fraud to other relevant organizations, such as the Office of Inspector General (OIG) Hotline, or the National Insurance Crime Bureau (NICB). The OIG accepts tips and complaints about potential fraud, waste, abuse, and mismanagement in the US Department of Health and Human Services' programs, including Medicare and Medicaid. The NICB also provides resources and tips to help individuals recognize and avoid medical fraud.
It is worth noting that healthcare fraud is a federal crime and can take many forms, including "doctor shopping", prescription fraud, phantom claims, and medical identity theft. It is important to be vigilant and to protect your personal information to reduce the risk of becoming a victim of medical insurance fraud.
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Report to the Office of Inspector General (OIG)
If you suspect medical insurance fraud, you can report it to the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). The OIG Hotline Operations accepts tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement in the HHS's programs, including Medicare and Medicaid.
Before submitting a complaint, it is recommended to review the types of complaints that the OIG does and does not investigate, as well as the complaint process. The OIG provides information on its website about the types of complaints it addresses, such as complaints from HHS employees, grantees, or contractors about fraud, waste, abuse, or mismanagement in HHS programs; crimes, gross misconduct, or conflicts of interest involving HHS employees, grantees, or contractors; fraud, waste, or abuse relating to HHS grants or contracts; false or fraudulent claims submitted to Medicare or Medicaid; kickbacks or inducements for referrals by Medicare or Medicaid providers; and medical identity theft involving Medicare and/or Medicaid beneficiaries.
When submitting a complaint, it is important to provide as much information as possible about the allegation and those involved. This includes the name and contact information of the individual or business related to the complaint. Supporting evidence in electronic format, such as email communications, documents, billing records, or photographs, can also be uploaded with the report.
It is important to note that the OIG Hotline will not confirm the receipt of complaints or provide updates on any action taken. The OIG receives a high volume of complaints, and not every submission results in an investigation. However, all reports are valuable in helping to identify and address potential fraud, waste, and abuse in HHS programs.
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Be aware of free services
It is important to be vigilant when it comes to "free" services. If you are asked to provide your health insurance information for a "free" service, it is likely that the service is not actually free and could be fraudulently charged to your insurance company. This is a common scam, and it is likely that the fraudster is attempting to bill you and your insurance company for thousands of dollars for a service that is often low-cost or unnecessary.
Be cautious of telemarketers or door-to-door sales agents offering free medical supplies or services. They may ask for your Medicare number to complete the order, which is a red flag. Medicare Summary Notices may also show services that you did not receive, which is a form of fraud. Always check your explanation of benefits (EOB) and ensure the dates, locations, and services billed match what you received. If there are any concerns, contact your insurance provider and review your policy, EOB statements, and any other paperwork. Keep good records of your medical care and be aware of the health care services you receive.
It is also important to protect your personal identity and Medicare and Social Security numbers. Never give private information to people you do not know. Medical identity theft is a growing concern, with over 2 million Americans falling victim. This can result in erroneous information being added to your medical record or even the creation of a fictitious record in your name.
If you suspect fraud, you can report it to your insurance company, which likely has an online reporting system. You can also contact the FBI's Internet Crime Complaint Center (IC3) or the OIG Hotline Operations, which accepts tips and complaints about potential fraud in the U.S. Department of Health and Human Services' programs.
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Protect your Medicare number
Your Medicare number is a crucial piece of personal information that should be protected at all costs. Here are some essential steps to safeguard your Medicare number and prevent potential fraud or abuse:
Treat your Medicare card with utmost care: Guard your Medicare card as you would your credit card. Keep it secure and don't lend it to anyone except your doctor or trusted individuals who need it, such as insurers acting on your behalf or Medicare-affiliated entities like your State Health Insurance Assistance Program (SHIP). Always be cautious when providing your Medicare number to anyone, even at your doctor's office or pharmacy.
Be vigilant about "free" services: Be cautious if someone requests your Medicare information for a supposedly "free" service. Often, these services are not actually free, and your information could be used fraudulently to charge your insurance company. Always verify the legitimacy of such offers and remember that Medicare will never contact you to sell you anything or visit you at home.
Regularly review your receipts and statements: Stay vigilant by regularly checking the receipts and statements you receive from healthcare providers. Look for any discrepancies or mistakes in the billed dates, locations, and services. If you notice any irregularities or unfamiliar charges, contact your provider's office immediately. They can help clarify the charges or identify a billing error.
Understand how Medicare uses your personal information: Familiarize yourself with how Medicare utilizes your personal information. When you join a Medicare health or drug plan, they are required to inform you of how they will use your personal data. This knowledge will help you identify any unauthorized or improper use of your information.
Keep your Medicare number separate from your Social Security Number: Protect both your Medicare number and your Social Security Number. While they may be similar or even identical, it's important to treat them as separate pieces of sensitive information. Be cautious about providing your Social Security Number to anyone, as it can be used for identity theft or other fraudulent activities.
By following these steps, you can significantly reduce the risk of Medicare fraud and protect your personal information. Remember to stay vigilant and proactive in safeguarding your Medicare number and seeking support from official channels when needed.
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Frequently asked questions
Medical insurance fraud can happen anywhere and to anyone. It is important to protect your insurance information and treat it like a credit card. You should also check your insurance claims regularly and report any discrepancies to your insurance provider.
Medical insurance fraud can take many forms, including phantom claims for services never provided, using someone else's insurance information to obtain services, and upcharging for services.
If you suspect you are a victim of medical insurance fraud, you should report it to your insurance company or a relevant government agency, such as the FBI or the Office of Inspector General (OIG).
To protect yourself from medical insurance fraud, you should be cautious when giving out your insurance information, review your statements regularly, and report any discrepancies to your insurance provider. You should also be wary of "free" services or offers that seem too good to be true.
