Health Care Fraud Prevention and Reporting
Health Insurance Fraud
Health care fraud, waste and abuse have a negative effect on the health care industry and our nation. Health care fraud costs billions of dollars each year. It impacts all of us in the long run.
Health care fraud leads to:
- Higher health care costs
- Limited health care resources
- Lower consumer confidence in our health care system
Examples of health care fraud include billing for:
- A service that was never performed
- A more expensive service, supply or piece of equipment other than what was really provided
- The same service twice
We all need to work together to reduce health care fraud. Blue Cross and Blue Shield of New Mexico (BCBSNM) works to fight fraud with help from our:
- Employer groups
- Local, state and federal agencies and law enforcement
BCBSNM created the Special Investigations Department (SID) to fight fraud. The SID staff includes people from diverse backgrounds such as:
- Medical providers (doctors and nurses)
- Professional coders
- Insurance industry experts
- Law enforcement
SID also has a Data Intelligence Unit to partner with SID investigators to find and stop fraud, waste and abuse. When appropriate, SID refers fraud cases for criminal prosecution.
How do I report fraud?
If you suspect fraud, there are ways to report it.
- Report by Phone
The toll-free Fraud Hotline is available 24 hours a day, 7 days a week. You can remain anonymous or you can let us know if you want to be contacted.
- Report Online
Complete a fraud report
This online fraud reporting form can be completed and sent to the SID.
- Report by U.S. Mail
Blue Cross and Blue Shield of New Mexico
Special Investigations Department
5701 Balloon Fiesta Pkwy. NE
Albuquerque, NM 87113