Resources

Fraud is a major concern in the healthcare industry that costs tens of billions of dollars each year and harms patients and providers. We rely on providers and patients as a critical frontline resource for help in combatting fraud crimes and unnecessary costs.

We need your help to make a difference in reducing fraud and abuse. Anyone can remain anonymous when reporting healthcare fraud and abuse.

Information for Providers

Healthcare fraud and abuse can include:

• Billing for services the patient never received.
• Filing claims for unnecessary procedures.
• Filing a claim for a more expensive procedure than the one performed.
• Duplicate submission of a claim for the same service.
• Billing for durable medical equipment not ordered or provided.
• Billing for a covered service when the service provided wasn't covered.

To report possible healthcare fraud and abuse:

• Complete our Report Suspected Fraud and Abuse form.
• Call our toll-free hotline at 1-800-824-4391.

Resources:

• CMS’ website offers numerous resources that can be found using the search term “fraud”
• CMS fraud prevention training materials
• Office of Inspector General fraud and abuse laws

Information Related to Patients

Examples of healthcare fraud and abuse can include:

• Using an expired or fraudulent identification card to get medical services or medications.
• Lending an ID card to someone who isn't entitled to it.
• Adding someone who isn't eligible for coverage to a contract.
• Not removing someone from a policy when that person is no longer eligible.
• Forging or altering bills.
• Misrepresenting physical conditions or medical history in order to obtain multiple prescriptions.

Our member site, AlabamaBlue.com, provides information for patients to identify, prevent and report fraud and abuse.