Fraud & Abuse

Report Fraud

We protect you by preventing, finding and investigating health care fraud.
Health care fraud affects you in several ways. Your health care premiums could go up if we pay for services members do not need. Your premiums may go up if we pay for services for non-members, as well.

Fraud can hurt you in other ways. Medical tests you do not need and treatments from unqualified people put your health and safety at risk.

How Does BlueCare Tennessee Fight Fraud?

BlueCross BlueShield of Tennessee formed its Special Investigations Unit (SIU) in 1983. The SIU is the investigative arm of the BCBST Enterprise. It services all product lines. including but not limited to: BlueCare Tennessee, Medicare Advantage, State of Tennessee, and the Federal Employee program. The unit is made up of former state and federal law enforcement officers as well as a nurse coder. These highly-trained professionals work with a number of internal and external partners to prevent, detect, and investigate health care fraud.

How Can I Help?

You can help us find fraud. Read over charges listed on the Explanation of Benefits we send you. Let us know if we paid for tests or treatments you did not get or paid an amount you think is not right:

What Is Health Care Fraud?

Health care fraud is:

How Much Does Fraud Cost?

Experts say between three and 10 percent of health care costs are fraud. Those numbers add up quickly.

Are Other Groups Fighting Fraud?

Many groups and organizations fight fraud. They include:

Each state has a Medicaid Fraud Control Unit. Many insurance companies have dedicated employees to protect people against fraud, too.

Lawmakers help by passing laws to fight fraud.

How Do People Commit Health Care Fraud?

Health care providers can commit fraud by:

Members can commit fraud by:

People who are not members can commit fraud by:

Agents and brokers can commit fraud by:

Employers can commit fraud by: