Reporting Health Insurance Fraud

What is insurance fraud?

Health care fraud is intentionally making any false statement or misrepresentation on a claim, billing, receipt or any other associated materials with the intent of obtaining unwarranted payment. The cost of health care fraud affects everyone.

How to report suspected health care fraud

If you suspect health care fraud against Blue Cross and Blue Shield of Nebraska, let us know. All reports are confidential. Contact our Special Investigations Unit if:

  • someone uses an expired Blue Cross and Blue Shield of Nebraska I.D. card
  • a person loans an I.D. card to a person not entitled to it
  • someone adds another person not eligible for coverage on his or her Blue Cross and Blue Shield of Nebraska membership

A discrepancy between your records and the member’s records does not automatically mean fraud has been committed. It could be a simple error. Notify our Special Investigations Unit about the discrepancy so we can determine if genuine fraud has been committed.

Contact Us

Fill in the online form and send it to us electronically. This form is both secure and encrypted; our system won’t see your e-mail address.

Call the confidential fraud hotline at (877) 632-2583 Monday through Friday, 8:30 a.m. to 4:30 p.m.



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.