COLUMBIA, S.C.-- Following health insurance scams that have hit South Carolina recently, BlueCross BlueShield of South Carolina has added new tools for consumers to use to report fraud.

The company's Web site, SouthCarolinaBlues.com, now includes a confidential e-mail feature where individuals can report suspected fraud, information on how consumers can help stop fraud, and examples of fraud cases in South Carolina. This is in addition to the company's fraud and abuse hotline, 1-800-763-0703, which has been in operation for 15 years.

"We have ongoing efforts to protect consumers from scams and fight healthcare fraud that drives up costs. Every dollar taken by some con artist is a dollar stolen from vital services such as emergency or pediatric care," said Tommy Mills, director of investigations and compliance for BlueCross. "We work with local, state and federal law enforcement agencies to prosecute fraud, but our biggest ally in this fight is consumers," he said.

BlueCross has communicated in newsletters recently to warn members about the Rent-A-Patient scam in which "patients" are recruited and paid to go to clinics for unnecessary diagnostic tests and cursory exams and then are having unnecessary surgical procedures performed on them. The insurance companies or Medicare or Medicaid get billed for services and medical equipment that never actually were provided or weren't necessary.

Fraud is also committed by persons or companies portraying themselves as insurance agents or companies, or by insurance company employees. Here are some tips for consumers to fight fraud:

-- Never let someone else use your insurance ID card or any other personal identification information.

-- Read your explanation of benefit (EOB) statement sent by your insurance company after it receives bills for your visit to the doctor or procedures performed in hospitals or outpatient clinics.

-- Check to see that the billing referenced in the EOB is for services you received.

-- Don't accept money from anyone who says they'll pay you to see a doctor.

BlueCross has employed investigators, analysts, and fraud examiners certified by national associations, and the company is a member of the National Health Care Anti-Fraud Association (NHCAA), the S.C. State Attorney General's Insurance Fraud Task Force, and assists a national Blue Cross and Blue Shield Association anti-fraud task force. The NHCAA estimates that healthcare fraud costs consumers more than $50 billion annually. Thanks to help from consumers, BlueCross BlueShield of South Carolina was able to recoup more than $16.8 million in fraudulent billing in 2003.

 

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