December 2023
Each year, our Fraud Hotline receives calls reporting possible health care fraud, waste and abuse. Our Special Investigations Department reviews every call to determine if there’s enough information to investigate suspected fraud.
If fraud is suspected, we may conduct initial interviews and field audits to determine if fraud was intentionally committed. If the SID concludes no fraud occurred, the case may be referred to the appropriate business area to resolve the issue.
Some hotline reports have led to recovery efforts for inappropriate payment of claims and reimbursements, or to law enforcement for criminal prosecution. Hotline calls reporting extreme cases of fraud have resulted in criminal prosecutions.
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We encourage members and providers to call the Blue Cross and Blue Shield of Illinois Fraud Hotline at 800-543-0867 to report potential health care fraud, waste and abuse. The Fraud Hotline is available 24 hours a day, seven days a week. All calls are confidential and may be made anonymously. You can also file a report online. |
