How to Report Health Care Fraud
Health care fraud, waste and abuse create a negative effect on the health care industry. These cost billions of dollars each year. It impacts all of us in the long run. Health care fraud leads to:
Higher health care costs
Limited health care resources
Lower confidence in our health care system
Avoid Health Care Fraud
Protect your information.
- Contact Blue Cross and Blue Shield of Illinois if you lose your member ID card or if it’s stolen.
- If your personal information is compromised, report this at IdentityTheft.gov
Beware of “free” services.
- Beware if you are asked to provide your health insurance information for a “free” service. The service is probably not free. Your policy may be billed.
- Never share your personal information with callers you have not confirmed.
Check your explanations of benefits (EOBs) or claims on a regular basis.
If your plan provides EOBs or claims, be sure to check them. Contact BCBSIL if you have questions. Use the Member Services number on the back of your member ID card.
Reasons to Contact BCBSIL
BCBSIL can check your claims. We may refer concerns to our Special Investigations Department (SID). Here are some reasons why SID may review a claim:
- You did not request or receive a service or supplies.
- There is a concern with repeat billing of a service or supplies.
- You shared your health insurance ID number during a marketing call and now you have concerns.
We all need to work together to reduce health care fraud. BCBSIL works to fight fraud with help from our:
- Members
- Providers
- Employer groups
- Producers
- Local, state and federal agencies and law enforcement
BCBSIL's SID staff includes people from diverse backgrounds such as:
- Medical providers (doctors and nurses)
- Professional coders
- Insurance industry experts
- Law enforcement
SID also has a Data Intelligence Unit to partner with SID investigators. They work to find and stop fraud, waste and abuse. When needed, SID refers fraud cases for criminal prosecution.
