Reporting Fraud

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


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 1-877-632-2583 any time.



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.