Preventing health care fraud

Health care fraud ExternalLink is theft by deception, and is a significant concern for Blue Cross and the entire health insurance industry. According to National Health Care Anti-Fraud Association estimates, three to ten percent of what Americans spend annually on health care is lost to fraud — that’s between $30 billion and $140 billion a year.

What Blue Cross is doing about it

We take a proactive approach to detecting and investigating potential health care fraud and abuse. Blue Cross and Blue Shield of Minnesota has a Special Investigations Unit (SIU) to detect and investigate allegations of fraud. The SIU’s aggressive approach to the investigation of potential health care insurance fraud cases is reflected in its mission statement:

The mission of the Blue Cross SIU is to prevent, detect, investigate, report and, when appropriate, recover money lost to health care fraud and abuse. Blue Cross strives to protect all health care dollars that otherwise might be lost or wasted. Our SIU works with members and providers to address issues and concerns about fraud and abuse.

Common examples of fraud

  • Billing for services that were never provided
  • Billing for services more expensive than those that were actually provided
  • Performing medically unnecessary services solely to receive insurance payments
  • Misrepresenting non-covered treatments as medically necessary covered treatments to receive payment
  • Altering claims
  • Adding someone who is not eligible to insurance coverage or lending an ID card to family or friends

How you can help

Always check your Explanation of Benefits (EOB) statement for inaccurate charges and be alert to the types of fraud listed above.

Contact

If you suspect any of the above situations or if you have any questions, please contact our toll free hotline at 1-800-382-2000, ext. 28363. You may remain anonymous. If you are calling after hours, please leave a message.

You may also mail or fax us at:
Blue Cross and Blue Shield of Minnesota
Special Investigations Unit
P.O. Box 64560
St. Paul, MN 55164-0560
Fax: 651-662-1099

Or e-mail us at reportfraud@bluecrossmn.com