Fraud

We actively protect our members from fraud and abuse.

Fraud and abuse in healthcare is a serious problem that impacts us all.

Up to 10 percent of annual health care costs stem from fraud and abuse.1

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

Report suspected fraud

You can help identify fraud by:

  • checking your EOBs (explanation of benefits) for accurate:
    • 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.

There are many ways healthcare fraud can happen.

Examples of medical staff fraud are:

  • 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 patient fraud are:

  • filing claims for services not provided
  • forging or altering receipts
  • encouraging a healthcare provider to inflate or misrepresent the services provided
  • allowing others to use their health insurance card

Report fraud

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

  • Call our toll free hotline, open 24/7, at 888.612.1277. Callers may remain anonymous.

  • Mailing address:
    Capital Blue Cross

    PO Box 773737 
    Harrisburg, PA 17177-1132

  • Complete our online form.

  • Email us

    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 healthcare fraud, you may also contact the Office of the Inspector General.

  • Phone: 800.447.8477

  • Fax: 800.223.8164

  • Mailing address:

    Office of Inspector General 
    U.S. Department of Health and Human Services

    Attention: HOTLINE 
    P.O. Box 23489 
    Washington, DC 20026

  • Email: DHHS.gov