Last year the FBI estimated that between 3 percent
and 10 percent of all health care spending in the U.S.
went towards fraudulent claims. Fraud has real effects
on health care costs and quality of care. The IBC
Corporate and Financial Investigations Department
(CFID) continues to add value to our fight against
health insurance fraud, waste, and abuse (FWA).
CFID detects and investigates potential areas of FWA
with the help of confidential information received from
many stakeholders, including providers, members, IBC
associates, and the general public.
Information received assists our analysts, auditors, and
investigators in determining whether potential FWA has
occurred. Some of the most common potential FWA
schemes reported to CFID over the past year include:
- billing for services not rendered
- health care identity fraud
- prescription fraud
- improper use of procedure codes
- claim lines billed with units exceeding the medically
unlikely edits (MUE) limits, according to the Centers
for Medicare & Medicaid Services
If you suspect health care fraud against you and/or
IBC, we urge you to report it. All reports are
confidential; you are not required to provide your
name, address, or other identifying information.
Submitting a report
You have three options for submitting a report:
- Submit the Online
Fraud & Abuse Tip Referral
Form electronically.
- Call the confidential anti-fraud and corporate
compliance toll-free hotline at 1-866-282-2707
(TTY# 1-888-789-0429).
- Mail your report. Write a description of your
complaint, enclose copies of any supporting
documentation, and mail it to:
Independence Blue Cross
Corporate & Financial Investigations Department
1901 Market Street, 15th Floor
Philadelphia, PA 19103
As a result of CFID?s efforts last year, $65.8 million
was recovered in FWA-related claims and 38 fraud
cases were referred to law enforcement or regulatory
agencies. In addition, savings consisting of many times
the recovered amount were recognized through the
detection, prevention, and shutting down of improper
payments and schemes. Many of these recoveries and
referrals started with information someone provided to
CFID.
Please join us in the fight against health care
fraud.