Prevention and assistance tips as health care fraud grows nationwide


When Jimmy Davis introduced his Blue Cross and Blue Defend of Louisiana card at a well being care facility forward of a medical process, he was surprised 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 annually, 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 absolutely restored and he might obtain the medical remedy he wanted in a well timed trend.

“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. But it surely has definitely made me understand that there are lots of people who find yourself in the identical scenario.”

At Blue Cross, a devoted fraud division is concentrated completely on serving to individuals like Davis get the medical protection they pay for and wish. Kandyce Cowart, supervisor of particular investigations for Blue Cross, stated there are some frequent ways that rip-off artists use to attempt to benefit from individuals.

“A way of urgency is one thing we see lots,” Cowart stated. “They’re telling those who they need to take motion now or they may lose out. Many occasions, they’re asking for monetary info or cash. They are saying they want cash proper now. It’s all about making individuals really feel they need to do one thing instantly.”

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

“If somebody calls and asks to your Medicare or insurance coverage quantity, they wish to generate profits off of it,” Sibley stated. “If you’re 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 accessible to you while 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 happy to hold up and confirm the individual’s identification earlier than sharing any info.

“Don’t be afraid to be impolite,” she stated. “When you don’t know the individual and they’re attempting to interact 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 assessments or screenings which may be unwarranted.

“Folks wish 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 wish to stay longer,” Jarrell stated. “Concern is one thing we see lots – a concern of lacking out in the event that they don’t have this check.”

At Blue Cross, defending members is the highest precedence. The insurer has a devoted workforce to deal with fraud, waste and abuse, and they’re going to 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 part we will in regards to the dialog, together with what the caller requested for and what was offered,” Cowart stated. “There are telephone calls we will make instantly on the road collectively to place blocks in place. As soon as now we have that info, our subsequent steps rely on what occurred. We usually will search for claims and see the place we had been billed and the referring doctor, then work by means of 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’ll get assist. It may be seen on the Blue Cross and Blue Defend of Louisiana YouTube channel,

Jarrell stated fraud will 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 overview and a fact-finding course of.

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

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

Though some individuals could also be embarrassed or scared to report fraud, Bertaut stated it is important 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 bounce into motion, tell us your identification was stolen or any individual switched your plan with out your information. Our brokers are on these experiences instantly and they don’t cease till it’s resolved.”

When you’re concerned with 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


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