Fraud

We actively protect our members from fraud and abuse.

Fraud and abuse in health care is a serious problem that impacts us all. Up to 10 percent of annual health care costs stem from fraud and abuse.*

Our special investigators work with health care companies and law enforcement to detect and prosecute those who commit fraud and abuse.

Report Suspected Fraud


There are many ways health care fraud can happen.

Examples of fraud by medical staff include:

  • Billing for services not actually rendered
  • Billing for services not medically necessary
  • Billing for a more costly service than was actually performed
  • Waiving patient copays and deductibles and overbilling the insurance carrier
  • Accepting kickbacks for patient referrals

Examples of fraud by patients include:

  • Filing claims for services not provided
  • Forging or altering receipts
  • Encouraging a health care provider to inflate or misrepresent the services provided
  • Allowing others to use their health insurance card

You can help identify fraud by:

  • Checking your EOBs (Explanation of Benefits) for accuracy:
    • Dates of service
    • Services received
    • Amount charged
    • Guarding your member ID number as you would your credit card number.
    • Signing one claim form per visit.
    • Dating your claim form. This makes it easier for you to match bills with your EOB.

*From the The U.S. General Accounting Office

Report Fraud

If you suspect Medicare fraud or other health care fraud, please contact us.

Phone

888.612.1277
Toll free hotline open 24/7. Callers may remain anonymous.

U.S. Mail

Capital BlueCross

PO Box 773737
Harrisburg, PA 17177-1132

Online

Complete our online form.

Email

Fraud
When completing the online form or sending an email to us, please include as much information as possible (such as the name of the patient or provider, address and a summary of the allegations).

For Medicare health care fraud, you may also contact the Office of the Inspector General.

Phone: 800.447.8477

Fax: 800.223.8164

U.S. Mail:
Office of Inspector General
U.S. Department of Health and Human Services
Attention: HOTLINE
P.O. Box 23489
Washington, DC 20026

Email: Htips@os.dhhs.gov