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Fraud and abuse

Healthcare fraud

  • What is healthcare fraud?

    Healthcare fraud occurs when a false claim is deliberately submitted to a health plan. It affects virtually everyone, taking critical dollars out of our already financially overwhelmed healthcare system.

    The National Healthcare Anti-Fraud Association estimates that as much as $50 billion is lost annually in the United States to healthcare fraud. The U.S. General Accounting Office reports that this figure might even be as high as $120 billion. It’s easy to see why losses of that magnitude affect costs for consumers, providers and insurers.

    Those who commit healthcare fraud can face fines and/or jail terms. For example, making false or misleading statements on a health plan application carry a penalty of up to five years in prison.

  • How does Premera combat fraud?

    At Premera, it’s critical that we do all we can to prevent, detect, and investigate healthcare fraud and abuse by providers, producers, employer groups or members. Premera has a Special Investigations Unit to look into suspected instances of fraud. We also have a Fraud Hotline you can call anytime 888-844-8985 to report fraud.

  • How you can prevent fraud
    • Sign only one claim form per visit
    • Guard your health insurance ID number as you woruld credit card information
    • Check your Explanation of Benefits (EOB) for inflated charges, incorrectly billed services or dates of service, and any other false statements
    • Call our fraud hotline, 24 hours a day, 7 days a week, at 888-844-8985 to report possible fraudulent activity

© 2019 Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. Premera Blue Cross is an HMO plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 888-850-8526 (TTY: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.To join a Premera Blue Cross Medicare Advantage Plan, you must have Medicare Part A and Part B and live in the Premera Blue Cross Medicare Advantage service area (Island, King, Pierce, Lewis, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, and Whatcom counties in Washington). Members must select a Primary Care Provider (PCP) from the Premera Blue Cross Medicare Advantage Plans provider network. For accommodation of persons with special needs at sales meetings, call 888-868-7767 (TTY/TDD: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.