Fraud, Waste, and Abuse

About Health Care Fraud, Waste, and Abuse

Member Alerts

Learn about current scams and how you can keep your personal information safe.

Blue Cross Blue Shield of Arizona has a Special Investigations Unit dedicated to investigating allegations from anyone suspecting fraud, waste, and abuse.

According to the Centers of Medicare and Medicaid Services (CMS) the financial losses due to Medicare fraud, waste, and abuse is estimated to cost tax payers billions each year.

Definitions

Fraud

Intentional misrepresentation; deception; intentional act of deceit for the purposes of receiving payments that an individual or entity is not eligible to receive.

Waste

Generally refers to over-utilization of medical services that result in unnecessary costs, misuse of resources, and that may also be inconsistent with acceptable medical guidelines.

Abuse

Deliberate ignorance or reckless disregard of the truth; conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in payments that an individual or entity is not eligible to receive.

How to protect yourself from Medicare fraud, waste, and abuse:

  • Do not give out your personal information including your social security number, Medicare number and/or BCBSAZ identification number to anyone you do not know.
  • Do not consent to any solicitation of free medical services that require you to submit your personal identification numbers without checking with BCBSAZ.
  • Do not release personal or health information to callers you do not know who are requesting to send you products in the mail.
  • If you have a question or concerns about a service, prescription or product you received, always check with your primary care physician's office or call BCBSAZ Member Services at 1-800-446-8331.
  • Review your monthly explanation of benefits statements to make sure they match the visits you received the month prior.

Common examples of fraud, waste, and abuse:

  • Billing your health plan for services you did not receive.
  • Billing your health plan for prescriptions or products you did not approve of or receive.
  • Providing incentives such as waiving your copay or other out of pocket costs to entice you to visit their office or use their pharmacy.
  • Showing up unscheduled to your home to offer you medical supplies, products or services.

How you can report concerns

For more information about Medicare fraud, go to StopMedicareFraud.gov. If you suspect healthcare fraud, report it to the Centers for Medicare and Medicaid Services (CMS) at 1-800-MEDICARE (TTY: 877-486-2048) 24 hours a day, 7 days a week, or call the HHS Office of the Inspector General at 1-800-447-8477 (TTY: 800-377-4950). You can also visit
https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud to learn more.

You can also report suspected fraud, waste, or abuse to the Blue Cross® Blue Shield® of Arizona Special Investigations Unit by emailing SpecialInvestigationsUnit@azblue.com or by calling the confidential Fraud Hotline at 1-800-232-2345, ext. 4875 or 602-864-4875.

To confirm information about your Medicare Advantage plan or your providers, we are happy to help. You may call Member Services at 480-937-0409 (in Arizona) or toll-free at 1-800-446-8331 (TTY: 711). We are here 8:00 a.m. to 8:00 p.m., Monday through Friday from April 1 to September 30; and 7 days a week from October 1 to March 31.