Page 2 - Healthy Kids Now - Fall 2022

Help fight against fraud, wT aste, and abuse
he National Health Care • prescription fraud;
Anti-Fraud Association estimates • individuals and businesses selling
Join us in the fight
against health care fraud
If you suspect health care fraud against Independence and/or you, we urge you to report it. All reports are confidential.You are not required to provide your name, address, or other identifying information.You can report suspicious activity using any of the following three methods:
• Online. Submit the online Fraud
& Abuse Tip Referral Form.
• By phone. Call the confidential
anti-fraud and corporate compliance toll-free hotline at 1-866-282-2707 (TTY: 888-789-0429), 8:30 a.m. to 4:30 p.m., Monday through Friday.
• By mail. 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, 42nd Floor Philadelphia, PA 19103
Learn more
For additional information on how you can help fight fraud, waste, and abuse, please visit the Anti-Fraud and Financial Investigations section of our website.
that financial losses due to health
care fraud are in the tens of billions
of dollars each year. Health care fraud schemes continue to grow in complexity and seriousness and have real effects on health care costs and quality of care.
Independence Blue Cross’s (Independence) 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, employees, and the general public.
The information received assists
our analysts, auditors, and investigators in examining allegations of FWA.
There are several common types of fraud in the health insurance sector, which
can include:
• performing medically unnecessary
surgeries or treatments to generate
higher insurance payments;
• falsifying tests to justify unnecessary
medical actions;
• accepting kickbacks for patient
referrals;
• billing insurers for services that were
not rendered, or padding claims with charges for procedures that did not take place;
• upcoding, which is the act of billing for more expensive services or procedures than were actually performed;
• unbundling, which is the act of billing each step of a procedure as an individual procedure;
• misrepresenting non-covered treatments;
• waiving patient payments (copays or deductibles) and charging these costs to the insurer or benefit plan;
• billing a patient for more than their copay or deductible amount;
fake tests, treatments, and cures for
COVID-19;
• unsolicited emails, telephone calls,
or personal contact from someone claiming to be from a medical office, insurance company, or COVID-19 vaccine center requesting personal and/or medical information to determine recipients’ eligibility to participate in clinical vaccine trials or obtain the vaccine.
Health care fraud and abuse is a national problem, and your assistance is vital in helping us to prevent the problem. Simple tips that may help you prevent fraud and abuse include:
• Review your Explanation of Benefits
(EOB) to ensure accurate dates of service, names 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.
• Be cautious of unsolicited telemarketers and recruiters.
• Be cautious of any COVID-19 testing site that requires your financial or medical information in order to receive a free test.
• Photos of COVID-19 vaccination cards should not be shared on social media. Posting content that includes your date of birth, health care details, or other personally identifiable information can be used
to steal your identity.
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