The fight against health care fraud

Red flags

How can you assist us in safeguarding your health care dollars? Watch out for red flags that could indicate potential fraud.

Check your Explanation of Benefits Statement using the following guidelines. If you suspect potential health care fraud, please let us know.

Among the factors that could indicate potential fraud:

• Changes in items on the bill (for example, billing for the same services using a different procedure code after the first procedure was denied).
• Billing for services that are not covered by coding the service as a procedure that is a covered service.
• Alterations on the claim or patient's record (for example, dates inserted).
• Misspelling or misuse of medical terms.
• Services rendered in another state or on a holiday or weekend.
• Two billings for the same service.
• Billing for services that have not been rendered.
• Amount on the bill does not correspond to services rendered.
• Use of another person's insurance card.
• Alteration of receipts or claims.

Contact us: All reports kept confidential

If you are aware of any of the above situations or if you have any questions, please contact us. All reports are confidential. You may remain anonymous.

Phone our toll-free hotline at 1-800-438-2478.

Mail or Fax us:

Highmark Inc.
Special Investigations
P.O. Box 890138
Camp Hill, Pa. 17001-9782

Highmark Blue Cross Blue Shield
Special Investigations
P.O. Box 535070
Pittsburgh, Pa. 15253-5070

Fax: (717) 731-2858 or (412) 544-5804