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Fraud and abuse

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Fraud and abuse report form

To report suspected fraud or abuse, please complete the information requested below. Please be as detailed as possible. Incomplete or lack of information may prevent BCBSNC from investigating this matter fully.

* required fields

Your Information: (Optional — you may choose to remain anonymous)
First Name:	Last Name:
Street Address:	City:
State:	Zip :
Email Address:	Phone Number:	Evening phone number:

Insured's Information: (Person who carries the insurance)
Same as above
First Name:	Last Name:
Member ID Number:	This number may be found on the Member ID card and Explanation of Benefits statements.
Street Address:	City:
State:	ZIP Code:	Phone Number:

Person or Company Suspected of Fraud and Abuse:
*Name (person and/or company):	Street Address:	*City:
*State:	ZIP Code:	Phone Number:
*Date of Incident(s):

Description of Suspected Fraud or Abuse:
* Please provide as much detail as possible.

We appreciate individuals such as yourself taking the time to share your concerns by reporting suspected fraud, waste, or abuse. You are helping Blue Cross and Blue Shield of North Carolina lower the cost of health care for everyone.

If you have any additional questions or concerns, please call the Fraud Hotline at 1-800-324-4963.

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