Health care fraud, waste and abuse create a negative effect on the health care industry. These cost 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
Avoid Health Care Fraud
Protect your information.
- Contact Blue Cross and Blue Shield of Texas if you lose your member ID card or if it’s stolen.
- If your personal information is stolen, report this at IdentityTheft.gov.
Beware of “free” services.
- Beware if you are asked to provide your health insurance information for a “free” service. Your policy may be billed.
- Never share your personal information with callers you have not confirmed.
Check your Explanation of Benefits (EOB) on a regular basis.
- Contact BCBSTX if you have questions. Use the customer service number on the back of your member ID card.
Reasons to Contact BCBSTX
BCBSTX can check your claims. We may refer concerns to our Special Investigations Department (SID). Here are some reasons why SID may review a claim:
- You did not request or receive services or supplies.
- There is a concern with repeat billing of services or supplies.
- You shared your health insurance ID number during a marketing call and now you have concerns.
We all need to work together to reduce health care fraud. BCBSTX works to fight fraud with help from our:
- Members
- Providers
- Employer groups
- Producers
- Local, State, Federal agencies, and Law Enforcement
BCBSTX's 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. They work to find and stop fraud, waste, and abuse. When warranted, SID refers cases for criminal prosecution.