Help stop fraud

We actively protect our members from fraud and abuse.

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 explanation of benefits (EOBs) for accurate dates of service, services received, and amount charged.
  • Guarding your 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 provided, for services not medically necessary, or 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 your health insurance card.

Report fraud

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

  • Online – Complete our online form.

    Phone – 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

  • 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 (TTY: 800.377.4950)

  • Fax: 800.223.8164

  • Mail:

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

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

  • Online: OIG complaint form