Healthy Blue North Carolina Fraud, Waste, and Abuse

What is Fraud, Waste, and Abuse?

 

Healthcare fraud, waste, and abuse affects everyone in the U.S. Let’s make sure you know what it is, how to recognize it, and how to help us prevent it.

 

So, what exactly is fraud, waste, and abuse?

• Fraud is when someone purposely lies to a health insurance company, Medicaid or Medicare to get money.
• Waste is when someone overuses health services carelessly.
• Abuse happens when best medical practices aren’t followed, leading to costs and treatments that aren’t needed.

 

These are some of the ways our investigative team fights scams:

• Carefully reviewing claims and identifying red flags
• Keeping track of doctors’ billing patterns for unusual charges
• Working with other healthcare companies to recognize suspicious activity
• Partnering with law enforcement to investigate potential fraud
• Training all our employees to spot unusual claims

 

 

How Can You Help?

 

Beware of freebies. If you are unsure if a service or extra benefit is for your plan, call the Member Services number on your member ID card.

 

Avoid identity theft. Don’t leave your member ID card out and let us know if your card is lost or stolen.

 

Review your explanation of benefits (EOB). Your EOB is a snapshot of your doctor’s visit. When you review it, make sure the services listed match the services you actually received.

 

 

Reporting Fraud, Waste, or Abuse

 

If you think a member or doctor is involved in fraud, waste or abuse, you should report it.

 

You can report it in any of the following ways:

 

Call the Medicaid Fraud, Waste, and Program Abuse Tip Line at 877-DMA-TIP1 (877-362-8471).

 

Call the State’s Auditor’s Waste Line at 1-800-730-TIPS (1-800-730-8477).

 

Call the U.S. Office of Inspector General’s Fraud Line at 1-800-HHS-TIPS (800-447-8477).

 

Call our Special Investigations Unit at 866-847-8247.

 

Thank you for helping Healthy Blue’s efforts to find fraud, waste, and abuse.

 

What to learn more? Visit fighthealthcarefraud.com.