July 2022
Health Care Fraud is Not a Victimless Crime
Blue Cross and Blue Shield of Illinois (BCBSIL) participates in inquiries and investigations to identify and address potentially fraudulent activities. Our Special Investigations Department (SID) is committed to fighting fraud, reducing health care costs and protecting the integrity of the BCBSIL provider network.
The National Health Care Anti-Fraud Association (NHCAA) estimates that about 3% of all health care spending is lost to health care fraud annually.1 Some government and law enforcement agencies estimate the loss due to health care fraud is as high as 10% of the annual health care expenditure in the U.S. – more than $300 billion – each year.1
Most health care fraud in the U.S. is committed by a small minority of health care providers and by individuals posing as legitimate health care professionals.1 Common types of provider fraud may include:
- Accepting kickbacks for patient referrals
- Billing for unrendered services
- Billing for each step of a procedure as if they are separate procedures (also known as bundling)1
Financial losses caused by health care fraud are only part of the story. Individual victims of health care fraud include patients who experience medical identity theft, double billing or false marketing for medically unnecessary procedures.
The SID offers two ways to take action, 24 hours a day, seven days a week:
- File a report online, or
- Call the Fraud Hotline at 800-543-0867. All calls are confidential, and you may remain anonymous.
What else can you do to help prevent fraud?
Always ask to see the member's ID card for current information and a photo ID to help guard against medical identity theft.
1 National Health Care Anti-Fraud Association, The Challenge of Health Care Fraud, https://www.nhcaa.org/tools-insights/about-health-care-fraud/the-challenge-of-health-care-fraud/
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.