Insurance fraud a multi-billion dollar industry, team works to protect members
BATON ROUGE - Healthcare insurance fraud is a multi-billion dollar industry. At Blue Cross Blue Shield Louisiana there is a group of 14 people that make up the company's fraud team. That group takes calls, investigates schemes, and gets answers.
Kandyce Cowart is the manager of special investigations at BCBS Louisiana. Her team works to prevent nearly $10 million in losses every year.
"We protect not only the company, but our members and the community at large," said Cowart.
Awareness is the most important tool to stopping healthcare scams. The stories Cowart has heard will amaze you. They include getting Covid tests in the mail, durable medical equipment, back braces, medications, and calls requesting personal information. There's even a scam where members think they're dialing a BCBS number, but accidentally hit one wrong number and it connects them to a scam artist hungry for information. Another scam offers genetic testing and one that involves Covid testing - both are fake.
Last week, 2 On Your Side interviewed David Bryant who discovered several erroneous charges on his Explanation of Benefits. The charges were for Covid test kits he never ordered nor did he want. In Bryant's case, he never received the kits. If he had never checked his Explanation of Benefits, he would have never known the charges were there.
"They're just getting money out of it and not sending products out," said Bryant.
It's a scam that's happening nationwide.
"It's all about looking for things that are unexpected and calling someone and telling them what happened," said Cowart.
BCBS says checking your Explanation of Benefits is very important. If something is on an EOB that shouldn't be, it could be fraud. Cowart says a health insurance company will never call you looking for money, personal, financial, or health information.
"We're calling to verify your Medicare number, or we have a piece of equipment we need to deliver I just need you to verify your name, your address..." she said.
If you don't recognize a number, it's best not to answer. If you do answer and something seems suspicious, it's best to hang up and call a number you're familiar with to question what's going on.
"Being alert for things that don't seem right, strange offers, urgency - that's one of the big ones," said Cowart.
If someone on the other line says you have to take advantage of something right away or the deal expires, it's a red flag. Insurance companies won't offer you deals.
Earlier this month during Medicare Fraud Prevent Week (June 5-11), BCBS reminded everyone that the best way to fight fraud is to stop it from happening in the first place.
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