Healthcare fraud

How to avoid paying more than you should

The National Health Care Anti-Fraud Association (NHCAA) estimates that tens of billions of dollars spent on healthcare each year are the direct result of outright fraud. Money that goes to pay fraudulent claims makes everyone’s premiums higher and out-of-pocket costs go up, this is a problem that affects all of us.

Protect yourself

Be cautious of “free” medical services or exams, copayment or cost-share waivers or services advertised as “covered by insurance.” Services advertised like this could be fraud schemes designed to illegally bill you and your health plan.

You are the best defense against healthcare errors and fraud. Read your Explanation of Benefits (EOB) carefully to make sure that all the services you are being billed for are services you actually received. If you have questions about the services a provider has billed, contact their office first. In most cases, errors are the result of an administrative mistake, and the provider will gladly correct it.

How you can help

Here are a couple ways you can protect yourself from fraud:

• Keep track of your medical treatments and services and check your bills to make sure there are no errors. Always remember to write down:
  • The date you received medical care
  • Where the service took place
  • What services you received
  • The names of the providers
  • What tests or additional services were ordered or recommended
• When you get a statement from your provider, double check it to make sure the services and charges match your records.
• When you get a prescription, check the dosage, quantity and frequency of medication. If you have questions about a prescription, ask the pharmacist, check with your provider or call the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card to review your plan coverage.

Report fraud

If you suspect fraud, call Blue Cross of Idaho’s fraud hotline at 800-682-9095 or email fraudreporting@bcidaho.com.