Health Care Fraud Prevention and Reporting

Fraud may cost the health care industry (both public and private payers) more than $200 billion each year* and can lead to our members experiencing physical and mental harm as a result of schemes in which a provider performs unnecessary or dangerous procedures.

Preventing Health Care Fraud

Blue Cross and Blue Shield of Texas (BCBSTX) created the Special Investigations Department (SID) to fight fraud and help lower health care costs. The staff includes individuals with medical, insurance and law enforcement backgrounds, as well as data analysts experienced in detecting fraudulent billing schemes. The SID aggressively investigates reports of fraud and refers appropriate cases for criminal prosecution.

View the fighting fraud checklist

Reporting Health Care Fraud

If you suspect that BCBSTX or one of our customers has been defrauded or is being defrauded, report the matter to the SID immediately. Remember, health care fraud affects all of us, so please get involved and report your suspicions of fraud to the SID in any of the following ways:

• BCBSTX Fraud Hotline: (800) 543-0867
• Complete a blank fraud report
  This link takes you to the website of Global Compliance Services, an independent third-party vendor of BCBSTX. You will be directed to a blank fraud report that you can use to report your suspicions of fraud to the SID. The reports can be made on an anonymous basis or in your name.
• United States Mail:
  Blue Cross and Blue Shield
  Special Investigations Department
  300 East Randolph Street, 35th Floor
  Chicago, IL 60601

* Source: The Federal Bureau of Investigation (FBI), Financial Crimes Report to the Public for Fiscal Year 2008.