How Health Care Fraud Can Affect You!
CareFirst Medicare Advantage is committed to ensure that its providers - doctors and other health care professionals - are reputable and are able to provide quality care. In addition, CareFirst Medicare Advantage takes its responsibilities towards reducing cost, preventing waste, and uncovering potential fraud very seriously. That is because we empower all our employees and contractors to find, reduce, eliminate, or report fraud, waste, and abuse. However, there is always a possibility that a provider, or a consumer, will engage in unethical, potentially fraudulent practices. Even a single fraudulent claim can raise the cost of health care benefits for everyone.
What is health care fraud?
Health care fraud is a crime. Healthcare fraud means to deceive another, like a private insurer, by intentionally misrepresenting or concealing a material fact(s) in order to obtain money or property, such as health care coverage or benefits. Fraud takes many forms, and can include direct misrepresentations as well as half-truths and the knowing concealment of facts. Some examples of provider health care fraud are:
Health Care Fraud,Waste and Abuse can take many forms. Some common types of health care fraud, waste and abuse include:
Help avoid and prevent health care fraud.
Here are some easy ways you can protect yourself from health care fraud, and keep health care costs down for everyone.
Don't be a victim of identity theft.
If you think you've been a victim of identity theft or fraud:
Call any of these numbers:
CareFirst Medicare Advantage is working to minimize health care fraud.
Our Special Investigations Unit (SIU) is responsible for minimizing CareFirst Medicare Advantage's risk of health care fraud. The SIU partners with CareFirst Medicare Advantage's and our contractors’ Member Services, Provider Network and Claim Departments to help identify suspicious claims, stop payments to fraudulent providers and punish wrongdoers.
The SIU also works with state and federal law enforcement, regulatory agencies and other insurance companies to detect and prevent health care fraud and assist in the pursuit of restitution and/or prosecution of health care fraud offenders.
How to report potential cases of fraud
To report a potential case of fraud, call CareFirst Medicare Advantage’s dedicated compliance line at (410) 779-9323, 24 hours a day, 7 days a week. TTY users may call 711.
This hotline allows you to report cases anonymously and confidentially. CareFirst Medicare Advantage will make every effort to maintain your confidentiality. However, if law enforcement needs to get involved, CareFirst Medicare Advantage may not be able to guarantee your confidentiality. Please know that CareFirst Medicare Advantage will not take any action against you for reporting a potential fraud case in good faith.
You can also email us at ComplianceMD@CareFirst.com or write to us at:
CareFirst BlueCross BlueShield Medicare Advantage
1966 Greenspring Drive, Suite 100
Timonium, Maryland 21093
For potential medical or non-prescription fraud cases, you may report to the Medicare program directly, toll-free, at 1-800-Medicare (1-800-633-4227). The Medicare fax number is 1-717-975-4442 and the website is www.medicare.gov.
For more information, request the guide titled “Protecting Medicare and You from Fraud” by calling toll-free 1-800-Medicare (1-800-633-4227). TTY/TDD users should call toll-free 1-877-486-2048. A customer service representative can answer your questions 24 hours a day, 7 days a week.