Find a doctor Contact Us Find a plan Get care Stay healthy Resources Log in/Register Anti-fraud Anti-fraud and financial investigations How to Report Suspected Fraud and Abuse Please choose any one of the three options listed below. Telephone: Call our confidential Fraud Hotline at 1-866-282-2707 (TTY: 888-789-0429). 24 hours a day, 7 days a week. Online: Complete and submit our Online Fraud Report Form. Mail or Fax: Write a description of your complaint, enclose copies of any supporting documentation, and mail it to: Independence Blue Cross Corporate and Financial Investigations Department 1901 Market Street, 42nd Floor Philadelphia, PA 19103 215-238-2287 We will make every effort to keep all information that we receive confidential. What is Health Care Fraud and Abuse? Health care fraud and abuse is a national problem that affects all of us either directly or indirectly. National estimates project that tens of billions of dollars are lost to health care fraud and abuse on an annual basis. These losses lead to increased health care costs and potential increased costs for coverage. Specifically, health care fraud is an intentional misrepresentation, deception, or intentional act of deceit for the purpose of receiving greater reimbursement. Health care abuse is reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement. While Independence Blue Cross (Independence) believes that most providers, members, groups, and brokers are honest, there are a small number of people who try to take advantage of Independence and our members by engaging in health care fraud and abuse. Types of Health Care Fraud and Abuse Health care fraud and abuse takes many forms. The most common of these forms include: Providers Billing for services that were not provided Duplicate submission of a claim for the same service Misrepresenting the service provided "Upcoding" - charging for a more complex or expensive service than was actually provided Billing for a covered service when the service actually provided was not covered Members Using a member ID card that does not belong to that person Adding someone to a policy that is not eligible for coverage (i.e., grandchildren) Failing to remove someone from a policy when that person is no longer eligible (i.e., a former spouse) “Doctor shopping” – visiting several doctors to obtain multiple prescriptions Help Us Prevent Health Care Fraud and Abuse Independence takes the fight against health care fraud and abuse very seriously. That is why we have a department dedicated to preventing fraud and abuse: The Corporate & Financial Investigations Department (CFID). CFID includes a staff of trained professionals who carefully review all allegations of suspected fraud and abuse. CFID’s mission is to detect, investigate, prevent, prosecute, and recover the loss of corporate and customer assets resulting from fraudulent and abusive actions committed by providers, members, groups, brokers, and others. If you suspect that Independence and/or our members are victims of health care fraud and abuse, please report the matter to CFID immediately via any of the options listed above. Your assistance will help Independence in its continued efforts to combat the rising costs of health care. Health Care Fraud and Abuse Prevention Tips Health care fraud and abuse is a national problem, and your assistance is vital in helping us prevent the problem. Simple tips that you can take to help prevent fraud and abuse include: Review your Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported Protect your insurance card and personal information at all times Count your pills each time that you pick up a prescription Research your providers with your state's medical boards Report suspected fraud and abuse as soon as possible Reprinted with permission of the Blue Cross® and Blue Shield® Association Find a plan Individuals and families Employers Medicare Get care Find doctors and hospitals Prescription drug information Behavioral physical and emotional health Stay healthy Health and wellness perks Events IBX Insights Resources For employers For brokers For providers For members Independence Blue Cross About us Careers Newsroom IBX Foundation IBX Innovation © 2021 Independence Blue Cross. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania Sitemap | Legal | Privacy & other policies | Anti-fraud | Developer resources Facebook Instagram Twitter LinkedIn Youtube Pinterest Language access: Español | 官话/官話广东话 | Tagalog | Français | Tiếng Việt | Deutsche | 한국어 | ру́сский | язы́к | العَرَبِيَّة | मानक | हिन्दी | Italiano | Português | Kreyòl | Język | Polski | 日本語 | Pennsylvania Deitsch | ែខមរ | Diné bizaad