Health Care Fraud Prevention and Reporting

Health Insurance Fraud

Health care fraud, waste and abuse have a negative effect on the health care industry and our nation. Health care fraud costs billions of dollars each year. It impacts all of us in the long run.

Health care fraud leads to:

• Higher health care costs
• Limited health care resources
• Lower consumer confidence in our health care system

Examples of health care fraud include billing for:

• A service that was never performed
• A more expensive service, supply or piece of equipment other than what was really provided
• The same service twice

We all need to work together to reduce health care fraud. Blue Cross and Blue Shield of Texas (BCBSTX) works to fight fraud with help from our:

• Members
• Providers
• Employer groups
• Producers
• Local, state and federal agencies and law enforcement

BCBSTX created the Special Investigations Department (SID) to fight fraud. The SID staff includes people from diverse backgrounds such as:

• Medical providers (doctors and nurses)
• Professional coders
• Insurance industry experts
• Law enforcement

SID also has a Data Intelligence Unit to partner with SID investigators to find and stop fraud, waste and abuse. When appropriate, SID refers fraud cases for criminal prosecution.

Read the fighting fraud checklist

Learn more with the Fraud, Waste and Abuse video

How to Protect Yourself From Fraud, Waste and Abuse

How do I report fraud?

If you suspect fraud, there are ways to report it.

• Report by Phone
  1-800-543-0867 (Hotline for BCBSTX)
  1-800-337-8440 (Hotline for Federal Employee Program)
  1-877-327-2583 (Hotline for Blue Cross and Blue Shield Association)
  These toll-free Fraud Hotlines are available 24 hours a day, 7 days a week. You can remain anonymous. Or let us know if you want to be contacted.
• Report Online
  Complete a fraud report
  This online form can be completed and sent to the SID.
• Report by U.S. Mail
  Blue Cross and Blue Shield of Texas
  Special Investigations Department
  1001 East Lookout Drive, Tower A, 2nd Floor
  Richardson, TX 75082