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Healthcare Fraud
Healthcare Fraud & How it Affects You
Common Types of Healthcare Fraud
What You Can do to Combat Healthcare Fraud
How to Report Suspected Healthcare Fraud
Healthcare Fraud and how it affects you
| | | | | | | • | Healthcare fraud costs Americans an estimated $54 billion dollars annually. | | | • | Healthcare fraud is committed by a multitude of individuals including medical providers, members as well as pharmacies. | | | • | Healthcare fraud increases the cost of healthcare for everyone. | | | • | Healthcare fraud jeopardizes the overall healthcare of consumers. |
Common Types of Healthcare Fraud
| | | | | | | • | Services Not Rendered. | | | • | Billing for services that were not rendered to the member. | | | • | Misrepresentation of Services. | | | • | Billing for a covered service when an uncovered service was actually rendered. | | | • | Medically Unnecessary Services. | | | • | Billing for services that are not necessary for the treatment of the member. | | | • | Upcoding Services. | | | • | Billing for services that are more complex and at a higher reimbursement than the actual service provided. | | | • | Unbundling Services. | | | • | Billing for services separately instead of billing the code that includes multiple services. | | | • | Misrepresentation of Identity (member/provider). | | | • | Falsely receiving or billing for services under a covered member's identity. | | | • | Doctor Shopping. | | | • | Receiving various narcotic medications from a multitude of physicians through deceit. | | | • | Misrepresentation of Eligible Dependents. | | | • | Maintaining eligibility for or adding an individual who does not legally qualify for benefits under the Program. |
What You Can do to Combat Healthcare Fraud?
| | | | | | | • | Protect your health benefits identification card as you do your credit card. | | | • | Review your Explanation of Benefit (EOB) summary to ensure that the services billed were actually rendered. | | | • | Be selective in sharing your health insurance information. | | | • | Be cautious of free medical exams, co-payment/co-insurance waivers and advertisements stating "covered by insurance". | | | • | Provide timely eligibility changes. |
How do I report Suspected Healthcare Fraud?
Call the Fraud Hotline @ 1.800.337.8440.
Or Write to:
Audit Department
Blue Cross and Blue Shield of Vermont
P.O. Box 186
Montpelier, VT 05601
Or email:
Fraud_Issues@bcbsvt.com
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