Please choose any one of the three options listed below.
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Health care fraud and abuse is a national problem that affects all of us either directly or indirectly. National estimates project that billions of dollars are lost to health care fraud and abuse on an annual basis. These losses lead to increased health care costs and potential increased costs for coverage.
Specifically, health care fraud is an intentional misrepresentation, deception, or intentional act of deceit for the purpose of receiving greater reimbursement. Health care abuse is reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.
While Blue Cross and Blue Shield of North Carolina believes that most providers, members, groups, and brokers are honest, there are a small number of people who try to take advantage of Blue Cross NC and our members by engaging in health care fraud and abuse.
Health care fraud and abuse takes many forms. The most common of these forms include:
Blue Cross NC takes the fight against health care fraud and abuse very seriously. That is why we have a department dedicated to preventing fraud and abuse: the Special Investigations Unit (SIU). The SIU includes a staff of trained professionals who carefully review all allegations of suspected fraud and abuse.
Blue Cross NC's Special Investigations Unit's mission is to detect, investigate, prevent, prosecute and recover the loss of corporate and customer assets resulting from fraudulent and abusive actions committed by providers, members, groups, brokers and others.
If you suspect that Blue Cross NC and our members are victims of health care fraud and abuse, please report the matter to Blue Cross NC's SIU immediately via any of the options listed above. Your assistance will help Blue Cross NC in its continued efforts to combat the rising costs of health care.
Health care fraud and abuse is a national problem, and your assistance is vital in helping us to prevent the problem. Simple tips that may help you prevent fraud and abuse include:
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
© 2023 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.