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Understanding Fraud, Waste and Abuse

Fraud Prevention

The Cost of Fraud, Waste and Abuse

Fraud costs the health care industry $350 billion dollars every year.  See how it can affect you.

 

Preventing Health Care Fraud

Health care fraud, waste and abuse have a negative effect on the health care industry and our nation. These acts are not victimless crimes.  They affect individual Montanans and businesses alike, costing billions of dollars each year.  These crimes can be committed by medical providers, individuals and others who intentionally deceive the health care system to receive unlawful benefits or payments.   

Health care fraud can lead to:

  • Higher health care costs, including premiums.
  • Reduced health care resources.
  • Lower consumer confidence in our health care system.

Examples of health care fraud include:  

  • Providers charging for the same service multiple times.
  • Providers falsely billing for a service visit or supplies.
  • Providers submitting numerous claims for the same service. 
  • Using another person's health insurance or allowing someone else to use your insurance.
  • Impersonating a health care profession and providing or billing for health services or equipment without a license.
  • Creating or using forged prescriptions.
  • Selling your prescription medication to someone else.

We all need to work together to reduce health care fraud. Blue Cross and Blue Shield of Montana works to fight fraud with help from our:

  • Members.
  • Providers.
  • Employer groups.
  • Producers.
  • Local, state and federal agencies and law enforcement.