Fraud and Abuse

If you suspect health care fraud against Blue Cross and Blue Shield of Nebraska, let us know.

Call the confidential fraud hotline at 877-632-2583 any time.

What is health care fraud, and why is it a problem?

Fraud occurs when a dishonest member or provider lies on an application or claim form with the intention of receiving a payment from Blue Cross and Blue Shield of Nebraska to which they are not entitled.

As stated in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (18USC, Ch. 63, Sec 1347):

Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice to defraud any health care benefit program; or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care services.

The cost of health care fraud affects everyone.

What are common types of fraud?

• Providing false statements on an application;
• Submitting claims for services that were not performed;
• Misrepresenting services that were provided;
• Providing medically unnecessary services.

What are the penalties for committing health care fraud?

Health care fraud is both a state and federal offense. As stated in the HIPAA Act of 1996: (18USC, Ch. 63, Sec 1347), a dishonest provider or member is subject to fines or imprisonment of not more than 10 years or both. Making false or misleading statements on an application carries a maximum five-year sentence.

You can help!

Read your Explanation of Benefits (EOB) carefully. The EOB is your notification that Blue Cross and Blue Shield of Nebraska has paid a claim under your health care benefits plan. Look for:

• Incorrect dates of service;
• Services that you did not receive;
• Non-laboratory or non-X-ray providers that did not see or treat you.

Fraud Hotline

Call the confidential fraud hotline at 877-632-2583 any time.