Preventing fraud

Health care fraud could subject you to having your identity stolen, being overbilled for unnecessary services and more.

It's estimated that between 3 and 10 percent of the total spending on health care each year is lost to fraud and abuse of health care services. The vast majority of health care fraud is committed by a small number of dishonest health care providers.

Here are a few tips to help you protect yourself.

• Don't divulge information — Treat your insurance cards like credit cards and don't give out information to solicitors.
• Ask questions — Ask your doctor about the costs for the services, tests or treatments you receive and why they are being administered.
• Nothing is free — Beware of any offer for a "free" service. Often there are other charges for services you didn't actually receive.
• Beware of "copayment waiver" — Dishonest health care providers may bill for inflated costs when they waive your copayment.
• Get a second opinion — If the service, treatment or test seems unreasonable, get a second opinion before rushing into something.
• Keep track of medical visits — Be vigilant and keep track of all your doctor appointments, tests and procedures. If the services listed on your Explanation of Benefit Payments statement doesn’t match your records, immediately contact your insurance company.

Blue Cross Blue Shield of Michigan members who suspect health care fraud should call the Blues' Anti-Fraud Hot Line at 1-800-482-3787 or fill out our online form or downloadable anti-fraud complaint report (PDF).

Someone who claimed to work for Blue Cross Blue Shield telephoned an out-of-state member of a Blues plan and asked for the member's banking information.

The caller said the member had been overcharged and asked for the banking information because a refund could only be processed electronically. The member refused to provide the information, but requested a call-back number since the incoming number was blocked through caller ID. The phone number provided proved to be unlisted.

This matter is being investigated by law enforcement in the member's state of residence. Blue Cross Blue Shield of Michigan has not received any reports of similar efforts to obtain banking information from our subscribers.

Never give out personal or banking information over the phone or as a result of questionable inquiries from someone claiming to represent the Blues. Immediately report any suspicious activity to Corporate and Financial Investigations through the toll-free Anti-Fraud Hot Line: 1-800-482-3787.

Investigators have called the Detroit area one of the worst locations for Medicare fraud, and stories are legion. Last year, the FBI announced arrests and indictments in a $50 million Medicare fraud case centered in Michigan.

Let us know if you've experienced any of the following:

• An individual or organization claims to represent Medicare or Social Security and asks you for your Medicare or Social Security number, bank account number, credit card number, money or other personal information
• Someone asks you to sell your Medicare prescription drug card
• Someone asks you to get drugs for them using your Medicare prescription drug card
• You feel a Medicare prescription drug plan has discriminated against you on the basis of age, health, race, religion or income
• You were encouraged to cancel your plan
• You were offered cash to sign up for a Medicare prescription drug plan
• You were offered a gift worth more than $15 to sign up for a Medicare prescription drug plan
• Your pharmacy didn't give you all of the drugs in your prescription and has no plans to provide them later
• You were billed for drugs that you didn't receive
• You believe that you have been charged more than once for your premium costs
• Your Medicare prescription drug plan did not pay for your covered drugs
• Your received a different drug than your doctor ordered and your doctor did not allow substitution

If you suspect Medicare fraud, waste or abuse, please report it right away to the Medicare Anti-Fraud Hot Line: 1-888-650-8136.

The durable medical equipment benefit is usually used in response to an urgent need in our lives. We generally take a professional's word for what's best when it comes to our care. But take a minute to understand your benefit and ensure that it's being used properly for your care.

The Blue Cross Blue Shield of Michigan Guide for Suppliers of Durable Medical Equipment and Prosthetic and Orthotic Appliances states that:

"When the estimated duration of need (specified on the prescription) indicates the rental fee will exceed the purchase price, the patient should be advised to purchase the equipment. When the estimated duration of need indicates the purchase price will exceed the rental fees, the patient should be advised to rent."

The DME supplier must discontinue billing for equipment once rental payments meet the purchase price. At this time, the subscriber then owns the equipment. Some items, however, are only rented because of maintenance requirements. These particular items are listed in the BCBSM manual for this specialty.

It is important to read the contract when DME is first supplied and to monitor the rental payments. The supplier should agree that if the equipment is a rental and will be used for a significant period that rental charges will stop once the purchase price is met.