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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)


 


 


 



Insured's Information: (Person who carries the insurance)
Same as above


 

This number may be found on the Member ID card and Explanation of Benefits statements.


 



Person or Company Suspected of Fraud and Abuse:







   

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