Health care fraud

Billions of dollars in health care fraud occur each year. The crime, which is predicted to become even more common in the future, includes everything from health care identity theft to billing for health care services that were never performed. Losses from health care fraud lead to increased health care costs, which can make care more expensive for all of us. National estimates project that billions of dollars are lost to health care fraud and abuse on an annual basis.

Examples of health care provider fraud and abuse include:

Billing for services that weren't provided
Duplicate submission of a claim for the same service
Billing for durable medical equipment items that weren't ordered or provided
Misrepresenting the service provided
"Upcoding"—Charging for a more complex or expensive service than was actually provided
Billing for a covered service when the service actually provided wasn't covered

Examples of member fraud and abuse include:

Using a member ID card that doesn't belong to that person
Adding someone to a policy that isn't eligible for coverage
Failing to remove someone from a policy when that person is no longer eligible
Forging or altering bills
Misrepresenting physical conditions or medical history in order to obtain multiple prescriptions

Member notice: unauthorized phone calls and texts

Some of our мembers report receiving phone calls or text messages claiming to be from Blue Cross Blue Shield of Massachusetts. Members may be asked if they suffer from or experience pain and are offered free topical pain medicine, free DNA test kits, diabetic supplies, or durable medical equipment. Members may also be asked to confirm certain information like their member ID number, password, date of birth, doctor’s name, or date of last service.

These calls and texts are not from Blue Cross , nor did we authorize them. We would never ask for your password via text or unsolicited phone call. If you receive one of these calls or texts, don't give anyone any personal information. Our advice is to just hang up.

If you received a call or text like this, we encourage you to contact our Fraud Hotline at 1-800-992-4100 or email us at [email protected].

Remember, never share your personal information unless you are absolutely sure you're talking to someone you can trust.

Health care fraud and abuse prevention tips

At Blue Cross Blue Shield of Massachusetts, we're working hard to prevent and deter fraud, waste, and abuse, but we need your help. Simple tips that may help you prevent fraud and abuse include:

Never share your insurance card with another person. Protect it like you would a credit card.
Check your claims history by signing in to your account at MyBlue to verify that you received the services listed.
Report suspected fraud and abuse as soon as possible.