Reporting Fraud

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Anthem believes the vast majority of providers and groups are honest and share our interest in deterring health insurance fraud. However, a relatively small group of people may take advantage of Anthem and our policyholders. When someone takes advantage of Anthem, that person also takes advantage of you. 
That's why Anthem has a Special Investigations Unit to detect, analyze, investigate and refer for prosecution any alleged fraudulent practices by providers, members, groups, brokers and Anthem associates. Our Special Investigations Unit consists of investigators and auditors from Indiana, Kentucky, Ohio, Connecticut, Maine, New Hampshire and Colorado/Nevada. Anthem investigators have various backgrounds which includes law enforcement and claims administration. 
Anthem's Special Investigations Unit mission is "To protect the integrity of the healthcare system we serve through the detection and prosecution of those parties responsible for fraud against Anthem Inc. and its affiliated companies." 
What is Healthcare Fraud?
Fraud is when someone knowingly and willfully lies in order to get benefits or money from Anthem. It happens when a claim submitted to Anthem includes intentional misrepresentation of services and/or supplies. The following are a few examples of healthcare fraud:  
billing for services and/or supplies that were not furnished
altering claim forms to receive a higher reimbursement
soliciting, offering or receiving a kickback, bribe or rebate (e.g. paying for patient referrals in exchange for ordering of tests, services or equipment)
altered prescriptions or medical bills
How to Report Suspected Fraud?
To report suspected fraud, please contact the Special Investigations Unit in your area. If your area is not represented please contact any of the following offices to receive assistance.  
Connecticut 800-258-3258
Maine 800-285-7424
New Hampshire 800-203-3738
 
Please click here to submit an electronic referral.  
 
Health Care & Fraud Related Links
National Healthcare Anti-Fraud Association
Blue Cross and Blue Shield Association
National Association of Drug Diversion Investigators
Journal of American Medicine
Association of Certified Fraud Examiners
 

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use