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Fraud, Waste and Abuse

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About Health Care Fraud, Waste & Abuse

Blue Cross Blue Shield of Arizona has a special investigations unit dedicated to investigating referrals and tips from anyone suspecting fraud waste and abuse. According to the National Health Care Anti-Fraud Association (NHCAA), the financial losses due to health care fraud are estimated to be in the tens of billions of dollars each year.

In fact, $2.27 trillion was spent in 2011 on health care for more than 4 billion claims processed in the United States. While a small fraction of those are fraudulent claims, they carry a very high price tag. Health care fraud is a contributing factor to higher premiums and out of pocket expenses for consumers. Consumers can also experience financial losses caused by unsafe medical procedures, compromised medical records, falsified claims and stolen identify.



  • Intentional misrepresentation; deception; intentional act of deceit for the purposes of receiving payments that an individual or entity is not eligible to receive.


  • Generally refers to over-utilization of medical services that result in unnecessary costs, misuse of resources, and that may also be inconsistent with acceptable medical guidelines.


  • Deliberate ignorance or reckless disregard of the truth; conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in payments that an individual or entity is not eligible to receive.
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Confidential Reporting Options

  1. Hotline:
    Call the BCBSAZ confidential hotline to report suspected fraud, waste and abuse. You may request to remain anonymous.
    (602) 864-4875 or (800) 232-2345, ext. 4875
    Note: Hotline is available Monday through Friday from 8:00 a.m. to 4:30 p.m. and messages can be left at any time.
  2. Online Reporting Tool:
    Click here to begin your confidential report.
Online Reporting Tool
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More Information for Members

Common Examples of HealthCare Fraud, Waste and Abuse

  • Doctor shopping: bouncing from one doctor to another in order to obtain multiple prescriptions, often for a controlled substance.
  • Including misleading information on, or omitting information from, an application for health coverage: intentionally giving incorrect information to receive benefits.
  • Misrepresenting a relationship by adding an ineligible person to a policy.
  • Using ID cards that belong to someone else: using another person's insurance ID card to receive benefits.

Tips to Identify HealthCare Fraud, Waste and Abuse

Blue Cross Blue Shield of Arizona knows that one of the best defenses against fraudulent activity is an alert consumer. The following tips can help you to identify healthcare fraud:

  • Closely examine your "Explanation of Benefits" to make sure the service billed was the service received from the provider you visited.
  • Be cautious of free medical exams, co-payment waivers or advertisements stating, "covered by insurance." When it sounds too good to be true, it probably is.
  • Take note if you seem to be paying unusually high charges for regular services or if you're required to come in for an unusual amount of visits.
  • Understand your benefits.
  • Think of your health insurance ID card as being as valuable as your credit card. If lost or stolen, it could be used to gain access to drugs and services that may appear on your medical history.