BlueCross BlueShield of North Carolina

Medicare Fraud

What is Medicare fraud?

When doctors or medical suppliers bill Medicare for unnecessary costs or services that aren't medically necessary, that's Medicare fraud.

The most common types of Medicare fraud include:

Providers

  • Billing for services that weren't provided
  • Duplicating claims submissions for the same service
  • Misrepresenting services provided
  • "Upcoding," or charging for a more complex or expensive service than was actually provided

Members

  • Using a Medicare or BCBSNC member ID card that doesn't belong to that person
  • Adding someone to a policy that isn't eligible for coverage
  • Failing to remove someone from a policy when that person is no longer eligible
  • "Doctor shopping," or visiting several doctors to obtain multiple prescriptions.

Spotting Medicare Fraud

Here are a few tips for keeping an eye out for Medicare fraud:

  • Record the dates you get health care services or supplies and save receipts or statements you get from providers. Compare this information with your claims Medicare processes to make sure you or Medicare weren't billed incorrectly.
  • Check all Medicare notices you receive about your claims.
  • Learn more about protecting yourself and spotting fraud at StopMedicareFraud.gov.

Reporting Medicare Fraud

If you're charged for services or supplies that you think are incorrect and you know the provider or service charging you, you may want to call their office to ask for more information.

If you contact the provider or service, and you still suspect that Medicare is being charged improperly, call 1-800-MEDICARE (1-800-633-4227), TTY users call 1-877-486-2048.

BCBSNC and the federal government take Medicare fraud very seriously. If you need to speak to us, we have a department dedicated to preventing health care fraud and abuse, known as the Special Investigations Unit (SIU). The SIU reviews all allegations of suspected fraud and abuse.

If you need to reach SIU immediately:

We make every effort to keep all information that we receive confidential. Your assistance helps BCBSNC fight the rising costs of health care.

Related Links

Stop Medicare Fraud: A website from the U.S. Department of Health and Human Services and the U.S. Department of Justice. Committed to helping Medicare members report fraud.

U9427, 10/13

The information on this page is current as of 10/01/2013.

Y0079_6246 CMS Approved 10212013