The National Health Care Anti-Fraud Association estimates that financial losses due to health care fraud are in the tens of billions of dollars each year. Health care fraud schemes continue to grow in complexity and seriousness and have real effects on health care costs and quality of care. Independence’s Corporate and Financial Investigations Department (CFID) continues to add value to our fight against health insurance fraud, waste, and abuse (FWA). CFID detects and investigates potential areas of FWA with the help of confidential information received from many stakeholders, including providers, members, employees, and the general public. 

The information we receive assists our analysts, auditors, and investigators in examining allegations of potential FWA. Some of the most common concerns and/or suspicions reported to CFID over the past year include:

• billing for services not rendered
• prescription fraud
• inappropriate non-schedule II pharmacy and durable medical equipment utilization resulting from telemarketing schemes
• inappropriate use of specific service types (e.g., wellness)

Help your patients prevent fraud and abuse

Health care fraud and abuse is a national problem, and your assistance is vital in helping us to prevent the problem. Simple tips you can share with your Independence patients, our members, that may help prevent fraud and abuse include:

• review your Explanation of Benefits to ensure accurate dates of service, names of providers, and types of services reported;
• protect your insurance card and personal information at all times;
• count your pills each time you pick up a prescription;
• research your providers with your state's medical boards;
• report suspected fraud and abuse as soon as possible.

Join us in the fight against health care fraud

If you suspect health care fraud against Independence and/or you, we urge you to report it. All reports are confidential. You are not required to provide your name, address, or other identifying information. You can report suspicious activity using any of the following methods:

• Online. Submit the online Fraud & Abuse Tip Referral Form.
• By phone. Call the confidential anti-fraud and corporate compliance toll free hotline at 1-866-282-2707
  (TTY: 1-888-789-0429), 8:30 a.m. to 4:30 p.m., Monday through Friday.
• By mail. Write a description of your complaint, enclose copies of any supporting documentation, and mail it to:

Independence Blue Cross
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103

Learn more

For additional information on how you can help fight FWA, please visit the Anti-fraud and Financial Investigations section of our website.