Prevention and assistance tips as health care fraud grows nationwide


When Jimmy Davis offered his Blue Cross and Blue Defend of Louisiana card at a well being care facility forward of a medical process, he was shocked on the response. Unbeknownst to him, he now not had Blue Cross protection.

With a little bit of analysis, Davis, a Blue Cross Medicare plan member, realized that his identification had been stolen. He isn’t alone. Roughly 2.5 million senior residents in the USA are victims of such crimes every year, stated Mike Bertaut, a well being care economist with Blue Cross.

Davis reached out to his Blue Cross agent, who instantly began working with him and others with the insurer to resolve the issue. She made a number of in-person visits to Davis and navigated the paperwork course of to make sure his Blue Cross protection was totally restored and he may obtain the medical remedy he wanted in a well timed vogue.

“I used to be very pleased with how we dealt with it,” Bertaut stated. “His agent was extremely caring and empathetic and good, as are all of our brokers right here. Nevertheless it has actually made me understand that there are lots of people who find yourself in the identical state of affairs.”

At Blue Cross, a devoted fraud division is targeted fully on serving to folks like Davis get the medical protection they pay for and want. Kandyce Cowart, supervisor of particular investigations for Blue Cross, stated there are some frequent techniques that rip-off artists use to attempt to make the most of folks.

“A way of urgency is one thing we see so much,” Cowart stated. “They’re telling folks that they must take motion now or they’ll lose out. Many occasions, they’re asking for monetary data or cash. They are saying they want cash proper now. It’s all about making folks really feel they must do one thing immediately.”

Alice Sibley, an intelligence analyst with the FBI New Orleans workplace, stated some scammers could ask for an individual’s Medicare or medical insurance data, which may create a false sense of safety since they don’t seem to be asking for direct monetary data. Nevertheless, Sibley famous the results could possibly be simply as vital even when the particular person doesn’t give out their banking particulars.

“If somebody calls and asks to your Medicare or insurance coverage quantity, they need to make cash off of it,” Sibley stated. “In case you are paying for that, you need to have the ability to obtain these advantages. You don’t need another person to invoice that account for testing now and it’s not out there to you once you want it.”

Cowart stated many fraudsters will say they’re calling from a health care provider’s workplace or well being insurer as a way to create a way of belief and familiarity. If somebody receives such a name unsolicited, Cowart stated they need to be at liberty to hold up and confirm the particular person’s identification earlier than sharing any data.

“Don’t be afraid to be impolite,” she stated. “When you don’t know the particular person and they’re making an attempt to have interaction in a dialog about your well being care or your funds, it’s okay to hold up or stroll away with out sharing something.”

Chad Jarrell, an intelligence analyst with the FBI New Orleans workplace, stated some schemes additionally contain providing medical exams or screenings that could be unwarranted.

“Folks need to stay wholesome, particularly when they’re aged, so it’s all about making them really feel their well being is in danger and they should do one thing in the event that they need to reside longer,” Jarrell stated. “Worry is one thing we see so much – a concern of lacking out in the event that they don’t have this take a look at.”

At Blue Cross, defending members is the highest precedence. The insurer has a devoted staff to deal with fraud, waste and abuse, and they’ll step in to assist members who report these points. If a Blue Cross member feels they’ve fallen sufferer to a rip-off, Cowart stated they need to instantly name the fraud assist line at 1-800-392-9249.

“The very first thing we attempt to do is study every thing we are able to concerning the dialog, together with what the caller requested for and what was supplied,” Cowart stated. “There are telephone calls we are able to make immediately on the road collectively to place blocks in place. As soon as we now have that data, our subsequent steps rely upon what occurred. We usually will search for claims and see the place we had been billed and the referring doctor, then work via the paperwork to get the total story.”

Davis labored with Blue Cross to make a video about his story to let others know the way they will get assist. It may be seen on the Blue Cross and Blue Defend of Louisiana YouTube channel,

Jarrell stated fraud may also be reported to the FBI at 1-800-CALL-FBI. The hotline is staffed 24 hours a day, seven days per week, and all complaints are documented and addressed accordingly. They’re then assigned to an FBI agent or analyst for assessment and a fact-finding course of.

“Somebody will reply and communicate to them,” Jarrell stated. “If they’ve given financial institution data, they need to attain out to their financial institution to place a maintain on their accounts. There are issues folks can do to restrict their publicity, however they must report it to the suitable authorities for that to happen.”

Sibley famous that Medicare members also can report fraud by calling 1-800-MEDICARE or going surfing to, which connects to the Federal Commerce Fee.

Though some folks could also be embarrassed or scared to report fraud, Bertaut stated it’s critical to take action to make sure an individual continues to obtain the well being remedy she or he wants.

“No one goes to suppose much less of you,” Bertaut stated. “If you wish to see Blue Cross leap into motion, tell us your identification was stolen or any person switched your plan with out your data. Our brokers are on these experiences instantly and they don’t cease till it’s resolved.”

When you’re all for changing into a Blue Cross member or studying extra about defending your self with Blue Cross Medicare plans, please name 1-800-568-1417 (TTY 711) or go to