How to protect yourself against health care fraud

Health care fraud is a serious crime that increases health care costs for everyone and causes potential safety issues for many patients. Our Corporate and Financial Investigations Unit has put together the following tips to help protect you against health care fraud:

• Verify requests for patient information

  Health care provider offices may receive fraudulent requests for patient information, national provider identifier numbers and provider signatures by standard mail, email or fax. Always verify requests before sending responses.

• Verify patient ID

  Ask for a picture ID to ensure that the person presenting the Blue Cross Blue Shield of Michigan or Blue Care Network subscriber card is the owner of that card.

• Use proper billing codes

  Consult the CPT and ICD-10 codebooks and other resources to verify that the codes used are appropriate and accurate.

• Check patient history

  To help prevent prescription drug fraud, ask patients if they’re seeing or have obtained prescriptions from other doctors. Check reports from the Michigan Automated Prescription System, or MAPS.

• Safeguard prescription pads

  Prescription pads shouldn’t be accessible to patients. Prescription fraud schemes are often perpetrated by using stolen prescription pads or compromised e-prescribing passwords.

• Make patient agreements

  Enter into controlled substance or narcotics contracts with patients to express the importance of limiting usage of medications as well as evaluating potential for addictive behaviors.

If you suspect a request may be fraudulent, don’t respond to it

When we conduct mass requests for medical records or patient information, we often notify you through a provider newsletter article or a provider alert. If you’re suspicious of a request that you receive, you can call our Fraud Hotline at 1-844-STOP-FWA (1-844-786-7392) or send an email to StopFraud@bcbsm.com. We may ask you to share the request so we can check its legitimacy.

For more useful information, check out the Victimized Provider Project section** of the Centers for Medicare & Medicaid Services website. The Victimized Provider Project helps keep providers from being held liable for overpayment for claims paid that are the result of identity theft.

By working together, we can help eliminate fraud, which will improve patient safety and reduce costs.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.