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Fraud, Waste and Abuse
Reporting Concerns
MedicareBlue takes allegations of Medicare fraud, waste and abuse very seriously. If you think that you or a MedicareBlue PPO or MedicareBlue Rx member has been a victim of Medicare or health insurance fraud or abuse, please use the following phone numbers to report your concern.
Concerns about Prescription Drugs for MedicareBlue Rx or MedicareBlue PPO Members:
1-800-706-4071
Concerns about MedicareBlue PPO Claims or Providers:
1-888-457-3009
Medicare:
You may also contact Medicare directly with concerns about Medicare Advantage Plans, such as MedicareBlue PPO, or Medicare Prescription Drug Plans, such as MedicareBlue Rx, at: 1-800-MEDICARE (633-4227) 24 hours per day, 7 days a week. TTY/TDD users should call 1-877-486-2048
Examples of Fraud and Abuse
The U.S. General Accounting Office estimates that $1 out of every $10 spent for Medicare and Medicaid is lost to fraud, waste and abuse. That means that there is less money to help people like you who depend on these programs for health care. MedicareBlue is actively working to identify, investigate and prosecute health insurance fraud, but we need your help.
Some examples of fraud include:
- Billing for services or supplies that weren’t provided
- Altering claims to obtain higher payments
- Soliciting, offering or receiving a kickback, bribe or rebate
- Health care provider completing Certificates of Medical Necessity (CME) for patients not known to the provider
- Using another person's Medicare card to obtain medical care
These are some examples of abuse:
- Billing too much for services or supplies
- Claims for services that aren’t medically necessary
- Improper billing practices
Confidentiality
Every effort will be made to protect the identity of the reporting party. There will be no retaliation for good faith reporting.
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