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Understanding Fraud, Waste and Abuse

Prevención de fraude

The Cost of Fraud, Waste and Abuse

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

 

Prevención de fraudes en la atención médica

El fraude, el despilfarro y el abuso en los seguros de gastos médicos tienen un efecto negativo en el sector de la atención médica y en nuestro país. These acts are not victimless crimes. They affect individual New Mexicans and businesses alike, costing billions of dollars each year. These crimes can be committed by medical providers, individuals and others who intentionally decieve 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.

Todos debemos trabajar juntos para reducir el fraude en la atención médica. Blue Cross and Blue Shield of New Mexico trabaja para combatir el fraude con la ayuda de:

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